Infant Enrollment Intake Form (Page 2 of 2) in pdf

Infant Enrollment Intake Form

Social and Emotional development

Has your child been in child care before?

Yes

Does your child have a regular routine when at home?______________________________________________

__________________________________________________________________________________________

Is there anything we should know about your child's play with other children, by themselves, any concerns?

__________________________________________________________________________________________

What kinds of activities does your child enjoy? Are there activities your child avoids?

__________________________________________________________________________________________

Does your child have any siblings? ____________________________________________________________

Does your family have any pets? _______________________________________________________________

Who else lives in your house? _________________________________________________________________

What soothes your child? _____________________________________________________________________

__________________________________________________________________________________________

What frightens your child? ____________________________________________________________________

__________________________________________________________________________________________

Does your child have any favorite songs or games that comfort them? _________________________________

__________________________________________________________________________________________

What concerns do you have about leaving your child in care? ________________________________________

__________________________________________________________________________________________

Do you have any suggestions that will help ease your child’s transition into care? ________________________

__________________________________________________________________________________________

What are your expectations or hopes for your child at our child care center? _____________________________

__________________________________________________________________________________________

What are your expectations for the Children's Center and Center staff members?

__________________________________________________________________________________________

Is there anything regarding your family, extended family or child that you would like to share with us

__________________________________________________________________________________________

Infant Enrollment Intake Form Page 2