Let’s Get Acquainted!

Child’s Name____________________________________________

Birth date_______________________________________________

Parent’s Name(s)____________________________________________________

Address____________________________________________________________

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Home Phone___________________________

Work Phone____________________________

Names and ages of other family members:

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List a few of your child’s “favorites,” such as a favorite food, TV show, book or hobby:

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Your child’s strengths:

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Areas needing improvement:

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Educational needs of your child from your perspective:

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Does your family have any pets?_____________________________

Does your child have a nickname?___________________________

Does your child have any fears? (dolls, animals, etc.)

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Does your child have any allergies? (food, environmental, etc.)

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Is your child toilet trained? If yes, is there anything we need to know to aid us in this activity? (once an hour, any reminders, etc.)

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Is there any information about your family’s culture, ethnicity, language or religion that is important for us to know?

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Is there any particular aspect of the program especially important to your child or family?

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Are you willing to volunteer?

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Is there any other information you would like us to know about your child or family?

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PLEASE EMAIL INFORMATION TO:

minimeperformingartschildcare@yahoo.com