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New Infant Questionnaire
Child's Name
*
First
Middle
Last
Birth Date
*
Month
Day
Year
Nickname(s)
In case of an emergency, The Cedarhouse School should call:
Name
*
Relationship
*
Phone
*
Family Information
Sibling 1 Name
Birth Date
Month
Day
Year
Sibling 2 Name
Birth Date
Month
Day
Year
Sibling 3 Name
Birth Date
Month
Day
Year
Excluding parents, names of others living in the home:
Name
Relationship to child
Name
Relationship to child
Pet names and species
Languages spoken in your home
General Information
Milestones reached (check all that apply):
Rolling over
Sitting Up
Crawling
Pulling-up
Walking
Other
Other
Describe your baby’s temperament (e.g., colic, likes to cuddle).
What signs does your baby give of being hungry, tired or over-stimulated (e.g., pulls at ears, rubs eyes)?
How does your baby handle separation from you?
Describe any fears your baby has.
What soothing methods work best for your baby? (e.g., back rub, rocking, walking, swaying, pacifier, singing, etc).
Does your baby have any special comfort objects. If yes, please describe.
What activities does your baby enjoy?
Is there anything else we should know about your baby? What can we do to make this a comfortable, secure place for him/her?
Food & Eating Habits
What position does your baby prefer while bottle-feeding?
What position does your baby prefer while being burped?
What temperature does your baby like his/her bottles?
Very Warm
Luke Warm
Not Heated
Does your baby take breast milk or formula?
Breast Milk
Formula
If formula, please list brand:
Daily Schedule
Please describe you baby’s daily schedule between 7:15a.m.–6:15p.m.
Activity should include breakfast, lunch, snack, bottle, nap, etc. For feedings, please include typical amounts.
Time*
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
Time
Activity
Special Instructions
*If you don’t plan to come in and breastfeed on a regular schedule, please inform teachers when you are able to come in.