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Pre-Enrollment Questionaire

You do not need to submit this form unless you are also submitting the enrollment packet.

MM slash DD slash YYYY
Thanks for taking the time to complete our Questionaire. This will better enable us to determine if your child will benefit from our program. It will also help us to determine if we are equipt for your childs specific needs. Your responses will not be the sole determining factor in the enrollement of your child, but it will enable us to discuss issues and concerns prior to enrollment, avoiding misunderstandings in the future.
1. Has your child attend Daycare in the past 6 months:(Required)
2. Is your child completely potty trained?(Required)
3. If response to #2 is no, has potty training started?(Required)
5. Is your child currently in school?(Required)
6. Does your child have any medical issues that we may need to be aware of?(Required)
8. Is your child on any ongoing medications for the issue listed above?(Required)
9. Has your child ever been diagnosed with ADD, ADHD or any related diagnosis?(Required)
11. Is your child on any medications for the diagnosis listed above?(Required)
12. Which medications does your child take and will the center need to administer them?(Required)
13. If your child is in school, are they on any specific plans at his/her school.(Required)
14. If your child is enrolled, would you be willing to share his/her plan so that we can better assist your child with his/her needs?(Required)
15. Is there anything that you feel we should know in order to better care your child?(Required)
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