Child’s Name: _______________________________________
Child’s Birthdate: ____________________________________
Does your child have a nickname? _______________________
Does your child have any allergies?
Do you want your child to be presented with school breakfast and lunch?
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Has your child ever been in school or day care before? ____________________________________________________________________________________________________________________________________________________________
Which languages do you speak at home?
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What holidays does your family celebrate?
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Who are some important people in your child’s life?
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Is there anything you want to share about your child?
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What are your child’s reinforcers?
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Does your child have triggers?
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Is there anything else you feel is important for us to know?
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