Preference Survey

We would like to get some information on your child's preferences for different items and activities.
Child's Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Some children really enjoy looking at things such as a mirror, bright lights, shiny objects, spinning objects, TV, etc. What are the things you think your child most likes to watch?*
Some children really enjoy different sounds such as listening to music, car sounds, whistles, beep, sirens, clapping, people singing, etc. What are the things you think your child most likes to listen to?*
Some children really enjoy different smells such as perfume, flowers, coffee, pine trees, etc. What are the things you think your child most likes to smell?*
Some children really enjoy certain food or snacks such as ice cream, pizza, juice, graham crackers, McDonald’s hamburgers, etc. What are the things you think your child most likes to eat?*
Some children really enjoy physical play or movement such as being tickled, wrestling, running, dancing, swinging, being pulled on a scooter board, etc. What activities like this do you think your child most enjoys?*
Some children really enjoy touching things of different temperatures. Cold things like snow or an ice pack, or warm things, like a hand warmer or cup containing hot tea or coffee. What activities like this do you think your child most enjoys?*
Some children really enjoy feeling different sensations such as splashing water in a sink, a vibrator against the skin, or the feel of air blown on the face from a fan. What activities like this do you think your child most enjoys? *
Some children really enjoy it when others give them attention such as a hug, a pat on the back, clapping, saying “Good Job,” etc. What forms of attention do you think your child most enjoys?*
Some children really enjoy certain toys or objects such as puzzles, toy cars, balloons, books, a flashlight, bubbles, etc. What are your child’s favorite toys or objects?*
What are some other items or activities that your child really enjoys?*
Should be Empty:

We would like to get some information on your child's preferences for different items and activities.