Wunderkind Learning Pod Parental Questionnaire.
(FORM MUST BE COMPLETED PRIOR TO POD ATTENDANCE)
Child’s Name
First Name
Last Name
What name does your child like to be called?
Childs age
blanks
years,
blank
months.
Who is hosting the pod you are attending?
What date/dates is your child attending?
Please share two goals that you would like me to support your child in achieving
What are some of your child’s strengths?
What are some things that motivate your child and make them feel better when they are sad?
What are some of your child’s interests?
Use three words to describe your child?
Please list any allergies your child has
Email
example@example.com
Your Phone Number in case of emergency
Please enter a valid phone number.
Format: (000) 000-0000.
Name of additional adult who may collect your child
First Name
Last Name
Phone Number of additional adult
Please enter a valid phone number.
Format: (000) 000-0000.
I, the undersigned, as the parent/guardian of the above named child and I agree, in taking advantage of the child care services provided by Wunderkind Early Learning, to release and hold harmless, its directors, offices, employees and consultants from any and all claims, demands, suits, cost, and charges in connection with or arising out of provision of the learning pod, including, but not limited to, bodily harm or injury to my child, except only for loss, harm or injury occasioned by gross negligence or intentional misconduct by Wunderkind Early Learning. The learning pod may be outside, therefore I will send my child to the learning pod with suntan lotion applied, a hat and a full water bottle. Please print your name then sign.
Signature
I give permission for my child to have their photo taken (but no name to be used) for-
Recording and reporting directly to parent or guardian (personalized newsletter)
For use on Wunderkind website
For use on Wunderkind social media
Submit
Should be Empty: