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Initial Adjustment Form

Name of Child:_________________________________ Age:_____________ D.O.B.:________________

Enrollment Date:________________ Teacher’s Name:________________________________________

End of First Day

Who accompanied the child to the center?_____________________________________________________

How long did the person stay?______________________________________________________________

What did the child bring to the center?________________________________________________________

How did the child react to the equipment and activities?_________________________________________

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How did he react to the teacher:_____________________________________________________________

What was the child’s first day like?__________________________________________________________

End of First Week:

How do the parens feel about the child’s reaction to the Day Care Center?___________________________

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How has the child reacted to being away from his parents?________________________________________

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What toys or activities does he / she like?_____________________________________________________

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How is he/she adjusting to routines such as sleeping, eating, cleaning and toileting?____________________

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How is he/she reacting to his teacher?________________________________________________________

What was his first week like?_______________________________________________________________


End of First Month

How does the child appear now as compared to his/her first day?___________________________________

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How does his/her parents feel he/she is adjusting to the center?____________________________________


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