Place of birth or family heritage
Does the child have any medical problems? Please Specify.
Does the child take medications?
Is the child allergic to any food products? Are there any food restrictions?
Does the child live in a single parent household?
Check if the child is a foster child.
Check if there are official papers for the foster relationship.
Do we have a copy of the foster relationship papers?
Activities child enjoy with Parents:
Is the child allowed to watch TV?
List types of programs and the amount of time for each:
Are the child's grandparents living?
What is their relationship with them like?
Has the child been cared for outside the house (babysitter, pre-school, nursery, family members, day care)?
Is the child toilet trained?
List the child's siblings?
Activities child enjoys with siblings.
What do you want your child to gain from the MLE Learning Center Program?
What topics would you be most interested in discussing during parent meetings?
Enter the date of the most recent immunization form.
