Confidential Profile

Please complete this form prior to the start of camp.

Child's Name*

Nickname*

Date of Birth*

Month Day Year

Who lives at home?*

If either parent does not live with your child, please describe your child’s relationship with that parent:*

Are there other significant people in your child’s life you would like for us to be aware?*

Is there more than one language spoken in your home?*

YesNo

If yes, what language?

Spoken by whom?

How often?*

How does child tell you they are hungry?*

Liquids preferred:*

WarmColdRoom Temperature

Food allergies

Appetite*

Food Dislikes*

Food Preferences*

Medications taken out of camp hours*

Usual nap times*

Does your child use a comfort object at naptime?*

YesNo

If yes, what?

What is your child’s word for bottle*

What is your child’s word for blanket*

What is your child’s word for pacifier*

What is your child’s word for stuffed animal*

How do you help your child go to sleep?*

RockingBack RubChild lays down by himself/herselfOther

Child sleeps on*

BackSide

How do you rate your child with his/her peers?*

What is your child’s attitude towards adults?*

How much time does child spend with each parent?*

What types of activities does your child enjoy?*

Who administers discipline and what form?*

Have there been or are there any outstanding fears?*

Has there been stuttering, thumb sucking, nail biting, hair twisting?*

If yes, have any corrective measures been taken?

Previous group experiences*

Reaction of child when away from parents for any length of time*

Is there any additional information you would like us to know that would help us get to know or understand your child better?*

Parent/Guardian Signature*

Date*

Confidential Profile

Family and Home

Child’s Feeding Pattern

Child’s Sleeping Pattern

Child’s Social Development

Child’s Emotional Development

Experiences

Summer 2023 Camp Calendars

Photos/Videos

Registration

Contact us

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