GROUP EXPERIENCESWHAT IS/ARE YOUR CHILD’S FAVOURITE TOY(S)/ACTIVITIES?(Required)HAS YOUR CHILD HAD PREVIOUS PLAY GROUP EXPERIENCE?(Required) Yes No IF YES, HOW DID HE/SHE ADAPT?HOW DOES YOUR CHILD BEHAVE TOWARD OTHER CHILDREN [E.G., SEEKS OTHERS OUT, FEELS SHY]:(Required)EMOTIONALHOW DOES YOUR CHILD REACT WHEN LEFT WITH UNFAMILIAR PEOPLE AND/OR IN UNFAMILIAR SITUATIONS?(Required)DOES YOUR CHILD HAVE ANY PARTICULAR FEARS? PLEASE DESCRIBE:(Required)WHAT SUGGESTIONS DO YOU HAVE THAT WOULD HELP STAFF TO MAKE YOUR CHILD’S TRANSITION INTO THIS PROGRAM EASIER?(Required)PLEASE LIST THE NAMES OF THE SIGNIFICANT PEOPLE IN YOUR CHILD’S LIFE [E.G., SIBLINGS, GRANDPARENTS, ETC.]:(Required)PLEASE DESCRIBE THE GUIDANCE AND DISCIPLINE METHODS USED AT HOME:(Required)PRIMARY LANGUAGE SPOKEN IN THE HOME:(Required)OTHER LANGUAGES:(Required)NAME OF ENGLISH SPEAKING PERSON [IF NEEDED]PHONESIGNATUREEATING AND NUTRITIONLIST YOUR CHILD’S FAVOURITE FOOD:(Required)LIST ANY DISLIKED FOOD:(Required)PLEASE DESCRIBE ANY PARTICULAR EATING PATTERNS:(Required)ARE THERE ANY RELIGIOUS OR ETHNIC OBSERVANCES RELATED TO FOODS:(Required)SLEEPINGNAP TIME: HOW LONG TO SETTLE TIME OF WAKING:(Required)BEDTIME: HOW LONG TO SETTLE TIME OF WAKING:(Required)IS YOUR CHILD A DEEP SLEEPER, OR DOES (S)HE AWAKEN EASILY?(Required)DOES YOUR CHILD TAKE A FAVOURITE COMFORTER [E.G., BLANKET OR TOY] TO BED?(Required) Yes No IF YES, PLEASE DESCRIBE AND TELL US IF IT IS “NAMED”:(Required)WHAT IS YOUR CHILD’S MOOD UPON WAKENING?(Required)TOILETINGTOILETING IS YOUR CHILD TOILET-TRAINED?(Required) Yes No Partially PLEASE INDICATE YOUR CHILD’S FREQUENCY OR PATTERNS FOR BOWEL MOVEMENTS:(Required)DESCRIBE ASSISTANCE NEEDED FOR TOILETING:(Required)WHAT “SPECIAL” WORD DOES YOUR CHILD USE FOR:(Required)URINATION: BOWEL MOVEMENTSName of Parent/Guardian(Required)Date(Required) MM slash DD slash YYYY CAPTCHACommentsThis field is for validation purposes and should be left unchanged.