CHILD BIOGRAPHY
CHILD'S FULL NAME
PREFERS TO BE CALLED
BIRTHDAY:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PRIMARY LANGUAGE
OTHER LANGUAGE(S)
OTHER CHILDREN IN FAMILY:
Select the Number of Children to add
Please Select
1
2
3
4
NAME
BIRTHDATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NAME
BIRTHDATE
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Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NAME
BIRTHDATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
NAME
BIRTHDATE
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PETS
Select the Number of Pets
Please Select
1
2
3
4
Name
type
Name
type
Name
type
Name
type
2.What are your child's favorite indoor and outdoor activities, toys and books?
3. Is this your child's first preschool experience?
4. How does your child handle separations from you?
How do you help your child deal with separations?
5. How does your child react to strange or new situations?
6. Does your child have any fears? (dark, animals, loud noises, etc.)
How do you help your child dear with these fears?
7. How do you know when your child is tired?
8. In what situations do you feel your child is most independent? (not in need of adult assistance).
9. How would you describe your child's personality?
10. Are there things your child uses/needs as a means of comfort or security during times of stress or fatigue? (i.e. blanket, stuffed animal, bottle, thumb, etc)
11. What do you hope your child will gain from his/her experience in our program?
12. What values do you hope our program will reinforce or develop?
13. Please note any further information that you feel would
Other:
Parent's Signature
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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