Family Information Form

Child's Name *

First

Last

Name your child wishes to use at school

Date of Birth *//

Parent/Guardian Name *

First

Last

Hobbies/Interests/Occupation

Parent/Guardian Name

First

Last

Hobbies/Interests/Occupation

Please list all the people who live in your home. Please tell us their name, relationship to your child, age (of siblings) and your child's name for them.

Please describe past childcare arrangements, schools, or play groups.

Please note background information (aside from health) that may be helpful to the staff. Include information such as unusual pregnancy, delivery, or early development; separations from parent/guardian; parent/guardian separations, divorce, custody arrangements; your view of child’s current physical, social and language development; favorite playthings or themes; state of toilet use and terms used; food preferences or avoidances.

Additional information/notes/comments

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