Recruitment Questionnaire

Karolina's Academy

0 / 4 sections completed

Fields marked with * are required.

Attention:

Child Information

1. Child's first and last name *

2. Child's gender *

Boy Girl

3. Child's date of birth *

Medical and Development Information

1. Has the child previously attended a daycare or another kindergarten? *

2. Does the child have diagnosed allergies or chronic diseases? If yes – please provide details. *

3. Does the child take any medications regularly? *

4. Has the child been under the care of specialists (speech therapist, psychologist, physiotherapist)? If yes – please provide the reason and when. *

5. Is the child independent in dressing, eating, and using the toilet? *

Yes - Is independent in these activities Wears diapers, tries to eat independently, we practice independent dressing Other

6. Does the child require a special diet? *

Regular Vegetarian Dairy-free Other

7. How does the child react to new situations and people? *

8. What does the child like to do in free time with parents? *

9. What are his/her favorite games or interests? *

10. Please describe your child's characteristics (Is open, cheerful, smiling, quiet and shy, calm, likes to make contact with peers, is an individualist, quickly gets bored with started activities, has a need to be constantly moving, is very sensitive, likes to dominate, is explosive, etc.) *

11. Does the child have a nap during the day? *

Yes No Other

12. Has the child experienced any traumas? *

Yes No Other

Additional Information

1. What else should we know about your child?

2. How can we support your child in adaptation? *

Parent/Guardian Information

1. First and Last Name *

2. Email *

3. Phone

Date of start

1. When would you like to start the adaptation? *

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