Child Information Sheet

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CHILD INFORMATION SHEET
(Please complete one form for each non-disabled child attending)
Child’s Full Name:___________________________________________________
Preferred name to be called:___________________________________________
Gender:_____
Age:_____
Birthdate:_____
School Grade:_____
Parent’s Full Name:__________________________________________________
Date that this form is filled out:__________________________________________
List any medical conditions:____________________________________________
List any allergies:____________________________________________________
List special hobbies, toys, and interests of your child:________________________
__________________________________________________________________
__________________________________________________________________
Does the child take a nap? _________ If yes, what time of day?_______________
Does the child need any special items to help him get to sleep? (blanket, toy, bottle,
etc…)______________________________________________________________
Does the child need any special diets, snack, or formula? __________________
If yes, describe:________________________________________________________
If the child cries for no apparent reason, what should we check first?_______________
_____________________________________________________________________
Are there any other things that you would like to tell us about your child?____________
______________________________________________________________________
______________________________________________________________________

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