Day Care Assessment Form

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Day Care Assessment Form

  • To help us better serve your family, please complete this for to the best of your ability:
  • Briefly describe your family and any important issues we should be aware of (i.e. domestic relation concerns and/or court orders that pertain to order of protection, individuals who are not allowed to pick up your child/ children). Please be advised that this information will remain confidential and it is necessary to ensure the safety of the child/children and family.
  • SLEEPING
  • POTTY TRAINING
  • What word does your child use for:
  • FEEDING
  • GENERAL
  • PLEASE SELECT THE OPTION THAT BEST DESCRIBES YOUR CHILD