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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.

Health
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.

Social Relationships

Daily Schedule

Signature & Date
Sun, October 24 2021 18 Cheshvan 5782