Child Care Form For Parents

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Dear Parent,
Please help me help your child through orientation by completing
this form.
Child’s Name _______________________________
Please list your child’s favorite…
Breakfast food __________________________________________________
Lunch food_____________________________________________________
Snack food _____________________________________________________
Song __________________________________________________________
Books _________________________________________________________
Videos ________________________________________________________
Toy or stuffed animal ____________________________________________
Cartoon character _______________________________________________
Game _________________________________________________________
Inside activity __________________________________________________
Outside activity _________________________________________________
If my child has trouble falling asleep I usually: ________________________
______________________________________________________________
My child is afraid of: _____________________________________________
Other people who have regular contact and are involved with my child’s care
(grandparents, step parents, siblings, friends, etc.)…
Name _____________________Relationship ____________________
Name _____________________Relationship ____________________
Name _____________________Relationship ____________________
Name _____________________Relationship ____________________
Anything else you would like to share about your child to help him/her feel more
comfortable (especially in the first week when we are brand new to each other)…
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

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