LiceMeaslesRingwormMumpsSkin RashGerman MeaslesSoilingPolioStomach UpsetsScarlet Fever Urinary ProblemTuberculosisWormsWhooping Cough Does your child have any speech, hearing or visual problems? ______________________________________________________________________ ____ Would there be any restrictions to play or activities? ______________________________________________________________________ __ ______________________________________________________________________ __
About Your Child
Has your child ever been in child care before?_________ What type (center, familydaycare, grandma etc.)_____________ Was it a positiveexperience?____________________________________________________________ _____ Why are you looking for childcare?_________________________________________________________________ ___ How does your child feel about daycare and being left by his/her mommy/daddy? ______________________________________________________________________ ___ Are there any recent traumatic situations the child has been exposed to such as a deathin the family, divorce, new sibling etc.? ______________________________________________________________________ __ What is your normal method of discipline?_____________________________________________________________ __ What is your child's temperament? Are they easy going, hard to please, demanding,aggressive, etc. ______________________________________________________________________ __ ______________________________________________________________________ __
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