Child Profile Form Page 3
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4Name of Medication _______________________________ Dosage _________________________________
_
Instructions: ______________________________________________________________________________
Emergency Treatment: Please indicate any situations where emergency treatment and/or medication (s) may
be required by your child (i.e.: Epipen, puffers/inhalers, Benadryl).
Instructions: ______________________________________________________________________________
Allergies: a) Please list any medication allergies: _________________________________________________
b) Please list any food allergies: _______________________________________________________________
c) Any other allergies? _______________________________________________________________________
Additional Information: Indicate if there are any activities in which your child cannot participate.
__________________________________________________________________________________________
CHILD DEVELOPMENT
Self Help: In what way does your child need our help with the following self-help skills?
Dressing/Undressing: ________________________________________________________________________
Eating: ___________________________________________________________________________________
Toileting: _________________________________________________________________________________
Handwashing/Toothbrushing: _________________________________________________________________
Other: (ie: gross and fine motor skills) __________________________________________________________
Are there any hints/suggestions you could share with us to make your child’s transition to the centre a
positive one? ______________________________________________________________________________
__________________________________________________________________________________________
The “Good Things in Life”: Tell us a few things about your child…..
What does your child like to do? (i.e.: look at books, listen to music, play with other children, play
outdoors/indoors, toys, climb/run/jump, paint, computer/TV, imaginative play/dress-up)
_________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Is there anything else you would like to share with us about your child?
__________________________________________________________________________________________
__________________________________________________________________________________________
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