Teacher Info Sheet


Admission Date: _______
Hours Enrolled:_______
Withdrawal Date: _______
1222 E. Debbie Lane
Days Enrolled:________
Mansfield, Texas 76063
Director: Debbie A. Nicholls
CHILD’S FULL NAME: _____________________________________ Date of Birth: ________
CHILD’S NICKNAME: ______________________________________
PARENT’S or GUARDIAN’S NAMES: _____________________________________________
SIBLINGS: ____________________________________________________________________
PETS: ________________________________________________________________________
Has your child had previous experience in out-of-home daycare? _____ Full-time/Part-time
If so, was the experience successful? _____ If there were difficulties, please describe:_________
Does your child understand what is said to him/her? _______ Is his/her speech clear?_________
Has your child exhibited a dominant preference to (circle the one that applies)
Is your child completely toilet trained? ______ If so, what is their usual toilet routine? ________
Does your child accept correction easily? _________ What type of discipline and/or positive
reinforcement is used in the home? _________________________________________________
Do you read to your child routinely? ____ Does he/she enjoy the experience? _______ What is
your child’s favorite story or book? _________________________________________________
How much television does your child watch daily?________ What programs or shows does your
child watch? ___________________________________________________________________
What is your child’s favorite activity?_______________________________________________
Does your child have any extracurricular activities such as dance, karate, soccer, etc? ________
Does your child have any special dietary needs or food allergies?_________________________
(**If there is a special diet needed for your child, we will need a doctor’s note outlining details.)
Does your child have any other known allergies? ______ If so, please list and/or describe any
reactions, and treatments._________________________________________________________
Does your child take medications on a regular basis? ____ If so, please make sure that it is in the
original container with the child’s name, expiration date, and dosage. We must have a medication
log filled out and signed by the parent for us to be able to administer the medication.
List any special needs/problems that our child may have such as, allergies, existing illness,


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