Imaginations Learning Academy

Child's Character Analysis Record

Child's name: _____________________________Birth date: _________

Chronic illnesses: ___________________________________________
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Known Allergies: (Asthma, Hay Fever, Insect Bites, Medicines, Food, etc.)
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Medications Given Regularly: ___________________________________ _________________________________________________________

Child's favorite toys, activities, etc.: _____________________________

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Favorite Foods: _____________________________________________

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Briefly describe your child's behavior: ____________________________
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Is there anything that makes your child mad or upset? ________________
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How does your child display his/her feelings? _______________________
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Is there a method that works best for handling a situation with your child?
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Does your child have special needs? ______________________________
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Does your child take an afternoon nap? _______ If so, how long? ________
If not, please explain: ________________________________________ _________________________________________________________

Does your child use a special toy or blanket for naptime? _________________________________________________________

Name of previous daycare provider/center: ________________________ _________________________________________________________
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Phone number of previous provider/center: ________________________ _________________________________________________________

Reason for leaving previous daycare setting: _______________________ _________________________________________________________
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Other comments:
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Mother’s Signature/Date

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Father’s Signature/Date