World of Wonders: Child Information Form (SUTQ)
Child's Full Name
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Nickname (if any)
Who is in the child's immediate family?
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Who lives at home with your child?
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What is the primary language spoken in your home?
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Are there any special family arrangements, such as shared parenting, living in two homes, or custody specifications, etc.? Additional Details?
Are there any changes or transitions that your child has recently experienced or is experiencing? (divorce, new home, death of family member, friend or
Are there any cultural or religious practices of your family we should be aware of? (Dietary restrictions, clothing, head coverings, etc.)
Do you have any pets at home? If so, what are they and what are their names?
If your child has had previous care (daycare, home care setting, babysitter) please provide additional details such as name and care type:
Are there any foods your child should not be fed? (If you answer yes, additional paperwork may need to be completed). If yes: Please list
How would you describe your child's personality and behavior?
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Are there additional personality and behavior characteristics that would be useful to know about your child?
Are there things that frighten your child? If so, how does he/she react and what do you do to comfort him/her?
What routines/actions or items do you use to comfort your child?
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World of Wonders: Child Information Form (SUTQ)
What causes your child to feel angry or frustrated?
What methods do you use to respond to your child's negative behavior?
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Does your child use any special comfort or support items that help him/her go to sleep? If so, what?
Is your child toilet trained? If not, have you started the toilet training process? If you are currently in the process of potty training, please explain your process:
Does your child need assistance when using the toilet? If so, how?
What time does your child normally go to bed at night and wake up in the morning?
Does your child have trouble sleeping (Night terrors, trouble going to sleep, etc.)? Please explain.
What time(s), and for how long, does your child usually nap?
What might you and/or your child be anxious about as he/she starts in this program?
What are you and/or your child excited about as he/she starts in this program?
What are your expectations of this program? What other information would be helpful for the staff caring for your child to know?
Parent Signature:
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Date
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