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Eaton Early Learning Center |
| Please tell us a little bit about your child by filling in the questions below. |
| Does your child have any allergies? |
| ( ) No |
| ( ) Yes Please list and describe any steps you would like us to follow. |
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| Does your child have any special needs? (i.e. seizures, asthma, diabetes, heart disease, speech difficulties, etc) If so, please describe and give instructions for care. |
| ( ) Seizures |
| ( ) Asthma |
| ( ) Heart disease |
| ( ) Speech difficulties |
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( ) Other - Please describe. ___________________________________________________________________________________________ ________________________________________________________________________________________________________ |
| Does your child need help: |
| ( ) Dressing/undressing |
| ( ) Eating |
| ( ) Washing hands |
| ( ) Using the restroom |
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What does your child say when he/she needs to use the
restroom? ________________________________________________________________________________________________________ |
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( ) Other - Please explain ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ |
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List your child’s likes and dislikes. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ |
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List any fears or concerns your child may have. |
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| Has your child been cared for by others than parents? |
| ( ) No |
| ( ) Yes - Please list preschool experiences |
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| Please list any goals you would like to see your child achieve while attending preschool. |
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