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ELC Developmental History and Background Information

Please note: All field are required.  Please type N/A if info is not applicable.

Developmental History
Please provide information for Infants & Toddlers (marked*) as appropriate to the age of your child.

Any medications to be administered at school requires an additional form signed by licensed physician.

Eating Habits

Toilet Habits

Sleeping Habits
Please note: The American Academy of Pediatrics has determined that placing a baby on his/her back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and unexplained death of a baby under one year of age. If your child does not usually sleep on his/her back, please contact your pediatrician immediately to discuss the best sleeping position for your baby. Please also take the time to discuss your child's sleeping position with your caregiver.

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Signature & Date
Sun, October 24 2021 18 Cheshvan 5782