GETTING TO KNOW YOU INFORMATION FORM

GETTING TO know YOU INFORMATION form To be completed by parent/guardian prior to child s firs t day of attendance Child s Legal Name Birthdate Boy Gi rl Does Child Respond to A Ni ck name? No Yes Please State Nickname Parent/Guardian Name Occupation Parent/Guardian Name Occupation Parents are Married Singl e Di vorced Li ve Apart Live Together Wi d o we d Never Married Stepmother/Stepfather Name(s) I f Child Does Not Li ve Wi th Parents , Who Is Primary Caregi ver? Primary Caregiver Relationship To Child Length Of Pregnancy Child s Birth Weight Child s Heal th At Birth Please describe any health problems or concerns Was Child Hos pi talized For Any Length Of Time After Birth In Neonatal I ntensi ve Care?

GETTING TO KNOW YOU INFORMATION FORM . To be completed by parent/guardian prior to child’s first day of attendance . Child’s Legal Name Birthdate  Boy  Girl

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