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All About Me Form
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Parent Account Details
Parent's Full Name
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First
Last
Email
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Phone
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Emergency Contact Name
*
First
Last
Emergency Contact Phone
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Child Details
This information will be given to your child’s key worker who will be responsible for closely monitoring your child’s development.
Child's Full Name
*
First
Last
My family call me
*
Child's date of birth
*
I live at…
*
Are you in contact with any outside agencies?
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Yes
No
Which agencies are you in contact with?
Do you have a social worker?
Yes
No
Please provide details
My Family and Home Life
I live with…(include family members and pets)
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Other people who are special to me include…
My cultural background is…
Do you speak other languages other than English at home?
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Yes
No
At home we speak these languages…
The language I use mostly at home is…
*
English
Other
The language I use mostly at home is…
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Do you observe a religion?
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Yes
No
Tell us about the religion you observe, including important dates and celebrations, as well as if you go to a place of worship.
The type of house I live in is…
Do you have access to a garden to play in?
Yes
No
Sometimes
The places I like to visit include…
The things I enjoy doing with my family include…
MEALTIMES
Does your child have any allergies or intolerances to food?
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Allergies
Intolerances
Both allergies and intolerances
No
If yes, please provide details of your child's food allergy or intolerance including what they are allergic/intolerant to and what happens when they eat that food.
My child's favourite food is…
At mealtime, my child's feeding ability could be described as…
If applicable, my child's bottle feeding routine is…(if relevant include formula and feeding times)
SLEEP ROUTINE
How does your child go to sleep?
Does your child sleep during the day?
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Yes
No
Sometimes
My child's sleep routine is (include times)
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Where does your child sleep during the day?
Cot
Bed
Pushchair
Other
My child's comfort at sleep time is…
PLAYING & LEARNING
My child enjoys playing with…
My child is really good at…
My child needs help at these times and with these things…
My child doesn't like, or is frightened of…
When my child is upset, my child feels better when…
COLLECTING YOUR CHILD
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