Fundamentals Child Development Center, LLC

Pre-Conference Child Interest Form (18m-5y)

Please Note - To prevent this page from timing out and being unable to submit we strongly recommend not using your phone to fill out this form. Please use a desktop computer with a strong internet connection.

Email

First Name

Last Name

Name that your child likes to be called*

Siblings/Ages

Favorite Activities*

Describe your child’s personality.*
List any topics your child might be interested in learning about. (i.e. space, planets, animals, bubbles)*

Is there anything else you would like us to know about your child or family that will guide us in our understanding of your child?*

What do you hope to have your child accomplish while in our program? (i.e. self-control, letter knowledge, counting skills, social skills etc.)*

Pet(s) Name*

Language(s) your child speaks*

Favorite Books*

What is your child’s experience with group activities? (preschool, story hour, Sunday school, Nursery school)*

Is your child potty-trained?*
Yes
No
What terms does your child use when communicating (s)he has to use the restroom? (if potty trained)*

Is your child prone to diaper rash?*
Yes
No
If yes, did you provide diaper cream for child?

Special Instructions regarding application of diaper cream?

Does your child have difficulty separating from you? What can we do to comfort them or make transition easier? (special blanket, song, animal, lovey, etc.) *

What are your child’s eating habits or anything you would like us to know about meal times? ( do they eat slow, need reminders to chew)*

What is your child's sleep pattern or nap routine?*