Child's Developmental and Family Profile 25-26

We know and respect that every family has its own feelings, wishes, reactions, and practices, beliefs based on their own culture, language, experiences, and situations. We want to partner with you in order to build a positive relationship with you and your child. Please complete this profile so that we can provide the best possible care and learning environment for your child. If there are any questions that you are uncomfortable answering, please leave the section blank.


We recognize that much of the information on this form is duplicated from your application and enrollment paperwork. This form is for our certifications. Parents/guardians must fill this form out on their own. If you would like a paper copy please let the school office know. 

Child's Name

Child's Birth Date

Child's Sex

Does your child go by a nickname?

Family Information

Legal Guardians: Family members legally responsible for the child.

Name

Relation to Child

Name

Relation to Child

Name

Relation to Child

Name

Relation to Child

Names and ages of siblings (if applicable) 

Sibling Name(s) and Date of Birth

Parent's Marital Status

Child Lives with:

Was your child adopted?

Does your child know they are adopted?

Child's Race/Ethnicity

Parent/Guardian's Race/Ethnicity

Family Structure: Have there been any recent major changes (new birth, death of relatives, separation, family illnesses, etc. that have affected your child?) Please Explain:

Language(s) spoken at home:

What religion does your family practice at home:

Family Celebrations

Tell us about your family recreational activities

How would you like to be involved in your child's classroom and school?

What are your hopes and dreams for your child during these early years?

Personal Details About Your Child

Medical Conditions (example: hearing impairment, febrile seizures, Nursemaid Elbow etc.)

List any allergies (nuts, dairy, etc.)

Does your child have Asthma

Are there any special instructions for any of your child's special health needs such as allergies or chronic illness (e.g., allergies, asthma, hearing or vision impairments, eating needs, neuromuscular conditions, urinary or other ongoing health problems, seizures, diabetes, etc)

Please list any medications your child is currently taking:

What time does your child go to bed?

What time does your child wake up?

Does your child take a daily nap?

What time

Length of nap?

Is your child toilet trained?

What term do you use for urination?

What term do you use for bowel movement?

What are your child's fears (if any) and how do they respond to them?

As a parent I am most pleased about these things regarding my child:

How would you describe your child's temperament most of the time

Has your child been diagnosed with any developmental delays, special or behavioral needs?

Does your child have an Individual Education Plan (IEP) that your received from your child's evaluation team?

Would you feel comfortable sharing this with your child's teacher?

Any previous school experiences?

Where?

How would you describe your child's experience?

Relationship with Others

Who cares for your child other than your immediate family?

Playmates are typically

They prefer to play

They are confident

My child handles drop-off

My child likes to be with a particular friend

How do you comfort your child?

What method of behavior management/discipline do you use at home?

Describe your child's schedule on a typical day

Additional Parent/Guardian Comments

Your name

Your email