Early Learning Center | Whitewater, WI

DEPARTMENT OF CHILDREN AND FAMILIES

Division of Early Care and Education

dcf.wisconsin.gov

FAMILY INTAKE QUESTIONNAIRE

Free Text

LEARNING DEPOT CHILD CARE CENTER

CHILD'S FULL NAME

DATE OF BIRTH

PARENT/GUARDIAN NAME

TODAY'S DATE

WHAT KIND OF THINGS DO YOU DO AS A FAMILY? HOW DOES YOUR FAMILY SPEND FREE TIME?

DO YOU HAVE OTHER CHILDREN? HOW OLD ARE THEY? DO THEY LIVE WITH YOU?

WHAT IS YOUR CHILD'S PREVIOUS EXPERIENCE WITH CHILD CARE?

WHAT ARE YOUR ECPECTATION OF CHILD CARE?

TELL US ABOUT THE HOLIDAYS, TRADITIONS AND/OR CUSTOMS THAT YOUR FAMILY CELEBRATE. (WHAT ACTIVITIES DO YOU DO, WHAT FOOD DO YOU EAT, MUSIC YOU LISTEN TO, CLOTHING YOU WEAR.)

TELL US ABOUT SOME OF THE DIFFERENT OCCUPATIONS AND PROFESSIONS REPREENTED IN YOUR FAMILY.

WHAT ARE YOUR CHILD'S LIKES AND DISLIKES?

IS THERE ANYTHING YOU WOULD LIKE TO TELL US ABOUT YOUR CHILD'S TEMPARAMENT? (WHAT CALMS YOUR CHILD DOWN WHEN THEY ARE UPSET?)

HOW WOULD YOU DESCRIBE YOUR CHILD LEARNS?

WHAT IS THE MOST IMPORTANT THING THAT WE SHOULD KNOW ABOUT YOUR CHILD?

ANY OTHER ADDITIONAL COMMENTS OR INFORMATION YOU WOULD LIKE TO SHARE WITH US.

HOW WOULD YOU PREFER TO BE CONTACTED REGARDING INFORMATION ABOUT THE CENTER AND YOUR CHILD?

BRIGHTWHEEL MESSAGING

PHONE

IN WRITING