Questionnaire 1Your Child22nd Child3Grandparents Getting to Know Your Child1. Child's Name* First Last 2. What are your child's favorite activities? 3. Does your child have a security item?pacifier, blanket, stuffed animal, etc. Yes No What is it? When does your child use it? What do you call it? 4. Does your family have a pet? What is its name? 5. What time does your child typically go to bed? 6. Does your child nap? Yes No 7. Do other people care for your child? How often? 8. Does your child exhibit separation anxiety? 9. Does your child have any fears? 10. What behaviors are you finding challenging to deal with right now?11. Please describe your form of discipline at home.12. Do you have any concerns about your child? If yes, please explain.13. Does your child have any special dietary needs? If yes, what are they?14. As a parent, what are your expectations of your child’s growth and development while in our program?15. What goals would you like us to work toward together this year?16. Is your child potty trained? Is there anything specifice we should know related to toileting?17. Is there anything else you'd like us to know about your child?18. Are you interested in serving as a parent resource to our curriculum? Do you have special talents, skills, or cultural knowledge that you would like to share with our program? Second ChildDo you have a second child in school? Yes No HiddenShow 2nd child if answer is yes1. Child's Name* First Last 2. What are your child's favorite activities? 3. Does your child have a security item - pacifier, blanket, stuffed animal, etc.? Yes No What is it? When does your child use it? What do you call it? 4. Does your family have a pet? What is its name? 5. What time does your child typically go to bed? 6. Does your child nap? 7. Do other people care for your child? How often? 8. Does your child exhibit separation anxiety? 9. Does your child have any fears? 10. What behaviors are you finding challenging to deal with right now?11. Please describe your form of discipline at home.12. Do you have any concerns about your child? If yes, please explain.13. Does your child have any special dietary needs? If yes, what are they?14. As a parent, what are your expectations of your child’s growth and development while in our program?15. What goals would you like us to work toward together this year?16. Is your child potty trained? Is there anything specific we should know related to toileting?17. Is there anything else you'd like us to know about your child? Grandparent InfoWant your parents to receive Rosh Hashana and Chanukah cards? Enter their info below! We may also reach out to them for Annual Fund.Grandparents (Set 1) Mr. and Mrs.Mr.Mrs.Ms.Dr.Dr. and Mrs.Dr. and Mr. Rabbi and Mrs. Prefix First Last Please write their names as we should address their mail to, including both grandparents names if applicable, and if they have a specific title.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grandparents (Set 2) Mr. and Mrs.Mr.Mrs.Ms.Dr. and Mrs.Dr. and Mr.Dr. Rabbi and Mrs. Prefix First Last Please write their names as we should address their mail to, including both grandparents names if applicable, and if they have a specific title.Address 2 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Grandparents (Set 3) Mr. and Mrs.Mr.Mrs.Ms.Dr. and Mrs.Dr. and Mr.Dr.Rabbi and Mrs. Prefix First Last Please write their names as we should address their mail to, including both grandparents names if applicable, and if they have a specific title.Address 2 Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
