Beruflich Dokumente
Kultur Dokumente
Enrollment Packet
Please fill out these forms completely. Any questions that do not apply to your child please put
N/A. If you need assistance please call 352-222-111 or schedule and appointment.
General Information
Date of admission: _____________________ Age at Admission: _______________
Date of Discharge: __________________ Reason for discharge: __________________________
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Anticipated Days and Times of Attendance
Days Program
Parent Handbook
I acknowledge that I have received the parent handbook.
Parent/Guardian signature: __________________________________________
Please note any special health information we need to know about your child. (Ie: allergies,
special diets, chronic health conditions, special limitations)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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History and Background Information
Important information
Any speech difficulties? ______________________________
Special words to describe needs: ____________________________
Does your child use a pacifier? ____________ suck thumb _________________
Infants and Toddlers- Crawl________? Pull up to stand___________?
Walk with help______?
Eating Habits
Special characteristics/difficulties: ________________________________________
Special formula preparation:
______________________________________________________________________________
Favorite foods: ________________________________________________________
Food refused: _________________________________________________________
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Toilet Habits
Disposable or cloth diaper? _________________________
Has toilet training been attempted? ___________________________
Is your child ever reluctant to use the bathroom? _____________________________
Does your child have accidents? __________________________________
Relationships
How would you describe your child?
_________________________________________________________________________
Does your child have any fears?
_________________________________________________________________________
How do you comfort your child?
________________________________________________________________________
What discipline management is used at home?
________________________________________________________________________
What would you like your child to gain from his/her experience at childcare?
_________________________________________________________________________
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Emergency Information
Instructions to reach parent or guardian
1.____________________________________________________________________________
2.____________________________________________________________________________
2.____________________________________________________________________________
Name, phone number, address
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Resources:
http://www.mass.gov/edu/docs/eec/licensing/forms/family-child-care/family-child-care-
enrollment-packet.pdf
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