Interview sheets for DCP

[canadianjule]

sorry, I should have clarified...yes the form that they fill out about the child when they register with you...thanks!

[fruitloop]

All About Me
*
Child’s Name ____________________ _____ Nickname ____________________ ______
I have ____ brothers & ____ sisters, their names and ages are: ___________________ ____________________ ____________________ ____________________ _____________
How would you describe your child’s personality? ____________________ __________
____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ______

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Has your child been in childcare before? ( ) yes ( ) no If yes, please give last childcare provider, or daycare center’s information:
Name: ____________________ _________________ Phone (___)____________
Dates attended: from _____ to ______ Why was care terminated? _________________
____________________ ____________________ ____________________ _____________
*May I contact them for a reference? ( ) yes ( ) no

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Does your child have a regular bedtime schedule? ( ) yes ( ) no What time does
your child usually go to bed at night? __________ What time does your child
usually wake up in the morning? ___________ Does your child have trouble
sleeping? ______ Night Terrors? ____ Trouble going to sleep? _____ Other:
____________________ ____________________ ____________________ _________
If infant, how does your child sleep? stomach side back
What time(s) and for how long does your child usually nap? _________________
Are there any special dolls, blankets, etc. that your child needs to go to sleep?
____________________ ____________________ ____________________ _________
What is your child’s disposition upon waking up? happy, grouchy, clingy, slow,
____________________ ____________________ ____________________ _________

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Has or does your child have any known health problems? ( ) yes ( ) no If yes,
describe: ____________________ ____________________ ____________________ __
Does your child need regular medication? ( ) yes ( ) no If yes, what and when is
it given? ____________________ ____________________ ____________________ __
Does your child have any known allergies? ( ) yes ( ) no If yes, please list
allergens: ____________________ ____________________ ____________________ _
Special instructions in case of an allergic reaction: ____________________ _______
____________________ ____________________ ____________________ __________
Has your child had any of the following communicable diseases? chicken pox,
measles, mumps, other ____________________ ____________________ __________
Is your child prone to: upset stomach, colds, seasonal allergies, earaches,
headaches, sore throats, nose bleeds, other ____________________ ______________
Are there any indications of hearing or vision problems? ____________________ __
Has your child had any recent illnesses? ( ) yes ( ) no If yes, describe: ____________
____________________ ____________________ ____________________ ___________



Does your child have any physical or mental disabilities? ( ) yes ( ) no If yes,
explain: ____________________ ____________________ __________________
Do you have a back-up plan if your child is ill and cannot attend or becomes ill and must be picked up? ( ) yes ( ) no

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What are your child’s eating habits? (mind trying new things, times usually eats,
etc.) ____________________ ____________________ _______________
Child’s usual dining habits: (circle all that apply) high chair, booster seat, feeds
self, uses utensils, bottle, sipper cup regular cup, ____________________ _____
Does your child eat unaided? ________ Does he/she enjoy eating? ________
Does your child have a special diet? ________ Due to your child’s tastes,
allergies, reactions,*and/or religious beliefs, are there any foods that should not be served to your child?*( ) yes ( ) no
Please list these foods: ____________________ ____________________ ______
Favorite foods: ____________________ ____________________ _____________
Strong dislikes: ____________________ ____________________ _____________
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What are your expectations my Day Home and me? ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____

[canadianjule]

Thanks for posting that I have something very similar but I think I will add a couple of the things that you have on there too

[momto3plus1angel]

I always interview with a list of questions I want to know. So far I've only have one family get up set about it and they were a family I didn't really think I wanted anyways. I use the same form that fruitloop does when a new child first comes and most parents have felf much better getting to tell me about their childs day/needs.