KC Child Care Client Intake Questionnaire
Please complete this form to assist with the interview process. If you are providing information for multiple children, kindly specify each child's details separately. Thank you!
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Child information: Child(s) Name and Current Age(s) *
Care Schedule: What days and hours will you need care? Do you have a desired start date? *
Parent/Guardian Information: Please include full names and contact information (Email/Phone Number) *
Parent Guardian Information: What is your current occupation? Can you describe your typical work schedule? *
Pick-up and Drop-off Arrangements: Do you expect anyone other than the primary parents/guardians to assist with daily pickup and drop-off? If so, please specify their details. *
Has your child previously attended daycare? *
If you answered "yes" to the above question, could you please share what aspects of your previous childcare experience you liked and disliked?
Medication Requirements: Does your child take any daily medications?  Will they require medication administration during care hours? *
Potty Training: Is your child fully Potty Trained? *
Allergies & Dietary Restrictions: Does your child have any allergies or dietary restrictions? *
Infant Feeding: Has your infant started solids or purees? If so, please specify the types of foods they have been introduced to.
Eating Habits: How would you describe your child's eating habits? Would you consider them a "picky eater"? *
Personality: Could you please describe your child's personality and characteristics? *
Interests and Preferences: Could you please describe your child's interests and any particular dislikes they may have? *
Social Interaction: How does your child engage in group play? For example, how well do they share and take turns with others? *
Learning Needs: Could you please provide details about your child's learning needs and any specific areas where you believe additional support would be beneficial? *
Sleep Pattern:  Could you please describe your child's sleep patterns, including whether they have a regular nap time? *
Sleeping Arrangements: Does your child co-sleep? *
Sleeping Arrangements: Is your child still sleeping in a crib or pack 'n play? *
Custody Arrangement’s: Is your child part of a custody arrangement? *
If yes, please specify the parties involved and the terms of the agreement. Kindly note that a copy of the custody agreement will be required if care is pursued.
Daily Routine: Could you please provide a description of your child's typical daily schedule? *
Communication Channel Preference: Which communication channels do you prefer for updates and correspondence? *
Discipline and Consequences: Could you please describe your preferred approach to handling discipline and consequences, and how it is executed at home?
Concerns & Transitions: Could you please share any general concerns or worries you have regarding your child's transition to a new child care environment? *
Questions & concerns: Do you have any questions or concerns that you would like to discuss with me? *
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