Does your child have a friend or relative who will be attending our preschool, if so then who?________________________________________________________________________________________

Favorite topic for discussion____________________________________________________________

Favorite game/activity___________________________________________________________

Favorite tv show and/or cartoon____________________________________________________

Favorite song and/or book________________________________________________________

Favorite hero/heroine____________________________________________________________

Favorite color__________________________________________________________________

Favorite food__________________________________________________________________

Special Abilities_____________________________________

Favorite animal or Family pet (name and species)____________________________________________________________________

Brothers/sisters (names and ages)_________________________________________________

Temperment__________________________________________________________________

Activity level___________________________________________________________________

Other interests_________________________________________________________________

What type of assistance will your child need in using the restrooms?
Is your son comfortable with a urinal?
Does your child need assistance getting on to the potty?
Does your child need assistance in wiping?
Does your child need assistance with clothing fastners:
snaps? buttons? velcro? zippers? waistband ties?
elastic waistbands? belt buckles? or suspenders?
Is your child familiar with locks on restroom doors?

Anything else you would like to tell us about your child?________________________________
_____________________________________________________________________________
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What would your child like to know about the high school student who will be working with him/her? _____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Please attach a recent photo to the Interest Profile and return to:

Click on Teddy to Return to the
Mount Markham Human Development Preschool Page