Child Introduction Form

Building Blocks Child Development Center

Please help us get to know your child by telling us a little about their likes, dislikes,
daily routines, ect.
Childs Name: _________________________________________ Age: _____ Birthdate: _______________
Eating: ________________________________________________________________________________________
Sleeping: ______________________________________________________________________________________
Toileting: _____________________________________________________________________________________
Daily Activities: ______________________________________________________________________________
_________________________________________________________________________________________________
Fears: _________________________________________________________________________________________
Likes: _________________________________________________________________________________________
Dislikes: ______________________________________________________________________________________
Habits: ________________________________________________________________________________________
Favorites: _____________________________________________________________________________________
Tell us about where your child is developmentally: ______________________________________
_________________________________________________________________________________________________
What other information should we know/be aware of to care for your child as an
individual? We can better help your child when your inform us of situations and/or
events that might have an effect on him/her such as:

Divorce
Separation from a relative or friend.
Death of a relative or friend.
Other: _____________________________________________________________________________________

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