About Me Questionnaire - Sunflower Learning Center

Confidentiality Notice: This questionnaire is confidential. It will only be shared with the child care director, owner, and your child's primary teacher unless you pre-approve otherwise. Fill it out below and click Generate Filled PDF — your completed form will download immediately, ready to print and sign.

Child & Contact Information

Child's Full Name *

Date of Birth *

Parent/Guardian Completing This Form *

Preferred Method of Communication

Provider / Center Name

Previous Child Care Experience

Has your child previously attended child care?

Yes No

Type of setting (family child care, group care, etc.)

What did you like most about your child's previous child care setting?

What did you like the least?

About Your Child

What is important to you about your child's care?

Who is important to your child?

Does your child prefer to play alone or with other children?

Alone With other children

Does your child have a favorite toy or comfort object?

Yes No

What is it?

What is your child's current sleep schedule?

Does your child fall asleep easily?

Yes No

What is your child's mood like upon awakening?

What does your child like?

What does your child dislike?

Special things you say or do to comfort your child

Emotional Cues - How Do You Know When Your Child Is...

Happy

Sad

Mad

Tired

Other

How Does Your Child React When...

Something unexpected happens

Something happens they don't like

They are scared

Other

Health & Life Events

Does your child have any health issues?

Yes No

Please explain

Has anything happened recently that might affect your child?

e.g. New sibling, separation/divorce, moving, other family changes

Yes No

Please explain

Is there anything else you'd like to share to help us create a positive relationship with your child?

Foster Care & Signature

Is your child in Foster Care?

Yes No

Case Manager Name & Contact Information

Date *

The PDF will include a signature line for your handwritten signature.

Email a copy of the completed PDF

Uncheck the box if you don't want a copy emailed. You can also change the address above.