Preschool Or Daycare Form printable pdf download

Preschool Or Daycare Form

SUPPLEMENT B

Preschool or Daycare

Complete only if child is under 5 and not in public school.

Name of Child's Preschool/Childcare:

Length of time having attended this facility:

My child . . .

(Mark with X only if statement is true or mostly true.)

dislikes preschool/daycare or the present one. (Circle)

has had the following number of daycares or family home care facilities: life:

misses many days from preschool/daycare.

has transportation problems.

is not potty-trained.

is difficult for the teacher or care worker to manage.

often interrupts the teacher/classmates.

has trouble following classroom or daycare rules.

often doesn't play with other children or bothers teases or pokes, etc.).

seems more active than the other children.

has trouble sitting and listening during story or circle time.

is not liked by the other children.

needs testing.

If your child has had some of these problems, about how long ago did they start?______________

How much stress is your child under at preschool/daycare? (circle)

(little 1, 2, 3, 4, 5 much).

How many children per adult are in the preschool or daycare?

Are there others outside the family who provide care?

________The child care provider or teacher doesn't seem to care about our family issues.

Preschool Or Daycare Form