Additional Forms:

1st Class Early Learning Center

Child and Parent/Guardian Information Record:

All the information is requested so that I can get to know you and your child and help the adjsutment period go as smooth as possible. All information will be kept confidential.

Child's Name:                                      Date of Birth:

Address:

Phone:

Parent's Name:

Place of Work:

Address of Work:

Phone Number:                       Cel Phone or Pager #:

Other Parent or Guardian:

Place of Work:

Address of Work:

Phone Number:                       Cel Phone or Pager #:

Interests or Hobbies of Parent/Guardian:

In Case of Emergency, another Contact Person Would Be:

How Well Does Your Child Get Along With Other Children?

How Does Your Child Express His/Her Feelings?

What Behavior Do You Find Most Difficult to Handle?

What Method of Discipline Do You Find Works Best With Your Child?

Are There any "Family Rules" That I Should be Aware of?

What are Your Child's Favorite Activities?

EATING HABITS:

Child's Favorite Foods:

Food Dislikes:

Does Your Child Use a Fork?               Spoon?

RESTROOM HABITS:

Can Your Child Be Relied Upon To Indicate The Need To Use The Restroom?

How Does Your Child Indicate It?

How Often Does Your Child Have "Accidents?"

Any Special Concerns or Comments:

SLEEPING HABITS:

What is Your Childs' Napping Routine/Time at Home?

DAY CARE EXPERIENCES:

How Many Day Cares Has Your Child Been In?

Reason For Leaving Last Day Care?

Any Special Concerns/Comments:

Additional Information:

Please feel free to add anything that you feel is important:

Emergency Information:

Name of child: Date of Birth:

Name of Physician:

Phone Number of Physician:

Street Address:

City: State: Zip Code:

Name of Dentist:

Phone Number of Dentist:

Street Address:

City: State: Zip Code:

ROSTER/PHOTO/AND WEB SITE RELEASE FORM:

I give Patty Alwine my permission to place my childs' name and parents' name, address, and telephone number for the day care roster.

I give Patty Alwine permission to take occasional photos of my child while at day care. Photos would incluse, but are not limited to: outings, birthdays, theme activities, etc.

I give Patty Alwine my permission to place my childs' first name on the web site (https://1stclasselc.tripod.com/homebaseddaycare/)

This is for the purpose of informing me about my childs' day, upcoming events at day care, etc.

Additional Forms Would Include:

Child Release Form:

Medical Permission Slip:

Permission to Transport Child:

Medical Release Form:

Medical Information Sheet (shot records, illnesses, etc.)

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