J4KH Preschool Needs and Services Plan

PRESCHOOL NEEDS AND SERVICES PLAN
This plan is completed at the time of enrollment. Parent/guardian and teacher will initial and date every change and update to the original plan.
Child's Name*
Date of Birth*

MonthDayYear
Date
Date*

MonthDayYear
Date
Primary Caregivers of Child*
Other Family Members in the Home*
Is there a court order affecting this child?*

YesNo
If yes, please note that the parent/guardian must provide a certified copy of court order before the child may attend our program. If not, please be aware that as per the law, both parents will be afforded immediate access to the child. Please referto the parent handbook for further explanation of this policy or speak with the center director.
Who has cared for child other than parents?*
Has the child had group play experiences?*
Has the child had group play experiences?*
What are your child's favorite indoor and outdoor activities?*

Please list any favorite foods:*

	Breakfast	Snacks	Lunch
Favorite Food

What time does your child?*

Tell us a little bit about what comforts your child*
Please describe your child's personality.*
Does your child have any special needs? Please list any social, emotional, behavioral, physical, or learning disabilities*

Is there anything else you would like to share about your child?*
Parent / Guardian Email*
You will receive a copy of this PDF you just filled out thru this email address.
Parent / Guardian Signature*

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Date*

MonthDayYear
Date
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PRESCHOOL NEEDS AND SERVICES PLAN