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The Kin Discovery Questionnaire
Share what you know about your child to help us begin the Discovery Period with curiosity and respect.
Your Name
*
First Name
Last Name
Whatsapp Number to contact you
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
About your Child
Name of your child
*
First Name
Last Name
Preferred name or nickname for your child
*
Age
Her/his birth date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Languages Spoken
*
English
Spanish
German
Other
Who lives with your child?
*
Does your child have siblings?
Yes
No
If they do have siblings, tell us a little about them and their relationship
Do you have any pets?
Health & Safety
Does your child have any allergies?
*
Food
Environmental
Medication
Insect bites
None
Other
Please describe: Food restrictions or intolerances , Current medications, Current supplements, Medical diagnoses (if any), Developmental diagnoses (if any), Anything we should know to help keep your child safe?
*
Has she/he had any antibiotic treatment during the past two months?
*
Pregnancy & Early Years
For the following quetsions, only answer if you feel comfortable doing so. It would provide us with a better context and understanding of the nervous system of your child, but we understand it is sensitive information.
Please share about the way your child arrived into this world: pregnancy complications or relevant happenings during hat time, birth type, premature, NICU, breastfed, feeding difficulties, and anything that you consider relevant to this period.
Tell us about your child's sleeping journey. Did they struggle with sleep at nights or with naps during the day? How many times did they use to wake up during the night when they were a baby? Where they considered a colicky baby?
Share a bit about their milestones for reference and context: early, normal or late: walkers, talkers, toileting, are they picky eaters?
Does your child have had any therapies? If yes, please elaborate
Everyday Life
Tell us about your child today...
If someone met your child on their very best day, what would they notice first?
What makes your child laugh?
What fascinates them lately?
What could they spend hours doing?
What brings them peace?
What helps them recover after becoming upset?
What usually overwhelms them?
What environments seem hardest?
What environments seem easiest?
How do they usually ask for help?
How do they show affection?
How do they show frustration?
Typical sleep schedule (and do they struggle with bedtime or not)
The Sensory World of your Child
Which experiences does your child love:
Movement
Water
Music
Insects
Animals
Climbing
Messy play
Building
Reading
Drawing
Cooking
Swinging
Spinning
Sand
Mud
Other
Which experiences are usually difficult?
Movement
Water
Music
Insects
Animals
Climbing
Messy play
Building
Reading
Drawing
Cooking
Swinging
Spinning
Sand
Mud
Other
Are they sensitive to sounds, lights, smells?
Do they have food preferences or avoidances?
Anything else about their sensory world you'd like us to know?
Would you describe them as "sensory seeker"? Lot's of physical activity, likes to jump on top of you, climb, stump, messy play, being barefoot, stuffing their mouth with a lot of food? Or the opposite, prefers to keep clean, avoids physical contact, doesn't like tooth brushing, hair brushing, taking baths/showers? Or is it a mix of both. Please describe to best of your ability.
Regulation
When your child feels overwhelmed...
What usually helps?
What usually makes things worse?
How do you know your child is becoming overwhelmed?
How does your child usually recover?
The Relational World of your Child
How does your child usually interact with: Adults, Children, Babies, Animals, New people, Large groups, One-on-one
How does your child communicate when... Hungry, Scared, Excited, Overwhelmed, Needs space, Needs connection
About their autonomy: How do they respond to being interrupted? How do they respond to transitions? How do they respond to direct instructions? How do they respond to invitations?
How does your child usually learn something new? Watching? Trying? Listening?Building? Talking? Moving?
Family
What values are most important in your family?
What are you most proud of about your child?
What is currently the hardest part of parenting?
If you could change one thing about your family dynamics, what would that be?
Your Hopes as a Parent
What do you hope your child experiences here at Kin?
Is there anything you're secretly worried about?
What do you hope you experience as a parent?
If your child could answer one question for us... What do you think they would want us to know?
Thank you for taking the time to introduce us to your child.
This questionnaire is only the beginning.
Over the coming months, we'll continue learning through observation, play, relationship, and everyday life. We look forward to discovering who your child is, not by comparing them to anyone else, but by getting to know them as the unique person they already are.
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