Child Development Form
Child’s Name:
*
Academic knowledge
*
Fair
Average
Excellent
Social Skills
*
Fair
Average
Excellent
Emotional Skills
*
Fair
Average
Excellent
Physical Skills
*
Fair
Average
Excellent
Please List the opportunities your child has in playing with others Ex. neighborhood, Church, family, school camps
*
Your child’s favorites: (colors, activities, stories, games, toys)
*
Discipline methods that are effective at home:
*
Health issues
*
No
Yes
Healthy sleeping habits
*
No
Yes
Good variety of foods
*
No
Yes
Communicable disease (chicken pox, measles, pink eye)
*
No
Yes
Hospital stays
*
No
Yes
Frequent sickness
*
No
Yes
Allergies
*
No
Yes
Dietary restrictions
*
No
Yes
Disabilities
*
No
Yes
Medications:
*
No
Yes
Potty trained
*
No
Yes
If you answered yes to any of the questions,please explain below:
*
Your Email Address
*
Online Giving
Powered by SiteOrganic Giving