Infant Questionnaire

0 - 12 Months

Personal Information

1. Child’s full name:(Required)

Start Date:(Required)

Email(Required)

2. Does your child go by any other names?

3. Child’s birthday:(Required)

4. Any Allergies?

Food

1. What kinds of foods does your child like to eat?(Required)

2. What kind of milk/formula does your child drink?

How much at each feeding?

How often?

3. Does your child use a sippy cup or a bottle?

4. Does your child drink water or juice?

5. Does your child use a binkie?

Yes

Napping

1. How many naps does your child take each day?

About what times?

About how long?

2. Do you have any specific routine for getting him/her to sleep?

3. Is your child attached to anything (binkie, blanket, toy, etc)

Miscellaneous

1. Does your child have any habits, likes or dislikes we should know about?

2. Do you have any special techniques for calming down your child when he/she is upset?

3. Does your child particularly enjoy being in a bouncer, swing, or floor chair?

4. Is there something you are working on with your child that we can help you with?

5. Is there any other information that you feel would be helpful to us in getting to know your child?

6. Would you be interested in exchanging work in a specific area of expertise for childcare credit (e.g., plumbing, carpentry, landscaping, etc.)? If so, please specify.

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