New Student Questionnaire

Please add any comments in the spaces provided.

下記のNew Student Questionnaireは日本語での記入も可能です。数字は半角英数をお使いください。

**This information is kept confidential and is used only to enhance your child’s experience at Cherry Blossom Toddler Care.

**下記の情報は機密保持され、当園での生徒の経験を高めるためにのみ使用されます。

Student's Name

First Name

Last Name

Child's Nickname

Gender

Child's birthday

YYYY

Language spoken by the child

Parent's name

Parent's occupation

Language spoken by the parent

Parent's name

Parent's occupation

Language spoken by the parent

Names and ages of other children and adults living in the household:

Has your child had any other childcare experience? Please explain.

Have there been any recent major changes in your child’s life we should know about?

In general, how does your child react to anxiety or frustrated situations?

When your child is upset, what helps to comfort him/her?

Does your child have any special fears (dogs, storms, darkness, etc.)?

What activities does your child enjoy most? Any favorite toys?

Does your child have any special needs or a developmental delay we should know about?

Does your child use the toilet on his/her own? If so, What words does your child use for toileting?

What is your child's Japanese/English language goal?

Is your student still nap in morning and afternoon?

Please describe the daytime nap patterns and nocturnal sleep–wake pattern and how.

Does your child have special needs or ritual for napping?

What would you like us to know about your child?

What would you like us to know about your family?