Initial Child Profile (Confidential)
Trillium Montessori House
St Justus Church Hall,
Mount Pleasant, Paddock Wood TN12 6AH
Email address *
Full name of your child *
Your answer
Date of birth of your child *
Your answer
Is your child known by any other name/nickname? *
If yes, please specify. If No, type N/A *
Your answer
Please give details of names, ages of any siblings. *
Your answer
Who lives in your house? *
Your answer
Dietary restrictions *
What languages do you speak at home?
Your answer
Please provide details of any pets: *
Your answer
Does your child use a comfort item? *
Required
What is your child's routine at home? *
Your answer
What interests does your child have? *
Your answer
Does your child have any phobias? *
If yes, please specify. If No, type N/A *
Your answer
What is your child's concentration span like at home? *
Can you child dress her/himself? *
Is your child toilet trained?
Does your child share a bedroom? *
Does your child attend another playgroup or nursery? Please provide details of where and when your child attends. *
Your answer
Is your child looked after by another adult? What is their relationship to your child? For how long is he/she in their care? *
Your answer
Which primary school will your child attend? When? *
Your answer
Is there anything else that you would like to tell us about your child? *
Your answer
Were there any complications at birth?
Your answer
Has your child ever had to go to hospital for anything? Please specify for what
Your answer
Is your child on any medication/creams? If so, please specify *
Does anyone smoke in the house?
Would you be needing early starts or extended afternoon care? *
Will you be needing care in the school holidays? *
If yes, specify dates if known. If No, type N/A *
Your answer
When would you like your child to start? *
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Please state which days and sessions times you would like to attend. *
Required
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