Kidlet Kare Application
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Parent's Names
Child’s Name
Child’s Age
Child’s Birthday
MM
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DD
/
YYYY
Parents are
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Parent's Employers
Beginning date needing care
MM
/
DD
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YYYY
Hours needed for daycare - Start Time
Time
:
Hours needed for daycare - End Time
Time
:
Which best describes your child care needs?
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Has your child ever been left with another family member separate to yourself?
Has your child ever been in childcare before?
What type (centre, family daycare, grandma etc.)
Was it a positive experience?
Why are you looking for child care?
Does your child have separation anxiety? If so, please explain:
What is your child's temperament? Are they easy going, hard to please, demanding, aggressive, etc.
What are some of your child's favourite activities?
Are there any food restrictions?
Does your child have any special needs or concerns?
What are your child's napping habits?
What are your hopes/expectations for your child here?
Are your child's immunizations up to date?
Does your child have any known allergies?
Does your child have any medical conditions which I should be made aware of?
Does your child have any speech, hearing or visual problems?
Would there be any restrictions to play or activities?
Is your child potty trained?
Does your child have any "accidents"?
Has your child had experience playing with other children?
What language(s) are spoken at home?
What are your child's favourite activities, toys, books, or games?
Are there any other comments or information you would like to let me know about?
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