Common use of Developmental History Clause in Contracts

Developmental History. Age began sitting: crawling: walking: talking: *Does your child pull up? *Crawl? *Walk with support? Any speech difficulties? Special words to describe needs Language spoken at home *Any history of colic? *Does your child use pacifier or suck thumb? *When? *Does your child have a fussy time? *When? *How do you handle this time? HEALTH Any known complications at birth? Serious illnesses and/or hospitalizations: Special physical conditions, disabilities: Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions: Regular medications: EATING HABITS Special characteristics or difficulties: *If infant is on a special formula, describe its preparation in detail: Favorite foods: Foods refused: * Is your child fed held in lap? High chair? * Does your child eat with spoon? Fork? Hands? TOILET HABITS *Are disposable or cloth diapers used? *Is there a frequent occurrence of diaper rash? *Do you use: oil: powder: lotion: other: *Are bowel movements regular? How many per day? *Is there a problem with diarrhea? Constipation? *Has toilet training been attempted? *Please describe any particular procedure to be used for your child at the center: *What is used at home? Pottychair? Special child seat? Regular seat? *How does your child indicate bathroom needs (include special words): _ Is your child ever reluctant to use the bathroom? _ Does your child have accidents? *Does your child sleep in a crib? Bed? Does your child become tired or nap during the day (include when and how long)?

Developmental History. Age began sittingat which child crawled? Sat? Walked? Began toilet training: crawlingCompleted? Can child dress unassisted? Undress? Right or Left handed? Additional Information: walkingBehavior Habits Does child follow daily routine? How does child react to change in routine? What time does child eat breakfast? Lunch? Dinner? Naptime? How Long? Bedtime: talking: *Awakes at what time? Does your child pull up? *Crawl? *Walk with supportsleep well? Any special fears? What causes child to show temper? What methods of behavior control are used in your home? Frequent colds? Runs high fever easily? History of ear problems (infections, tubes, etc.) Ever had a seizure? If so, explain: Have you suspected or detected any speech difficultiesproblems? Special words to describe needs Please check any and all that apply: ❏ ❏ ❏ Hearing Problems Wears hearing aids? Vision Problems Wears corrective lenses? Food Allergies ❏ Downs Syndrome ❏ Speech/Language spoken at home *Any history of colic? *Does your child use pacifier or suck thumb? *When? *Does your child have a fussy time? *When? *How do you handle this time? HEALTH Any known complications at birth? Serious illnesses and/or hospitalizations: Special physical conditions, disabilities: Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions: Regular medications: EATING HABITS Special characteristics or difficulties: *If infant Delay ❏ Motor Development Delay ❏ Sensory Processing Challenges ❏ Autism Spectrum Disorder ❏ Asthma (Asthma Action Plan from doctor is on a special formula, describe its preparation in detail: Favorite foods: Foods refused: * Is your child fed held in lap? High chair? * Does your child eat with spoon? Fork? Hands? TOILET HABITS *Are disposable or cloth diapers used? *Is there a frequent occurrence of diaper rash? *Do you use: oil: powder: lotion: other: *Are bowel movements regular? How many per day? *Is there a problem with diarrhea? Constipation? *Has toilet training been attempted? *Please describe REQUIRED if any particular procedure to be used for your child at the center: *What medication is used at hometo manage asthma.) ❏ Any other disease, illness, or diagnosis that would affect his/her Sonshine School day ❏ None of the Above If any boxes above are checked, please provide additional information here: Any hospitalizations or injuries in the past year? PottychairIf so, what? Special child seatAny medications prescribed for long-term or continuous use? Regular seatIf so, what? *How does your child indicate bathroom Children with special needs (include special words): _ Is your child ever reluctant due to use challenging or limiting conditions will be required to submit care recommendations from a qualified specialist prior to admission to the bathroom? _ Does your child have accidents? *Does your child sleep in a crib? Bed? Does your child become tired or nap during the day (include when and how long)?Sonshine School program.

Developmental History. Age began sittingat which child crawled? Sat? Walked? Began toilet training: crawlingCompleted? Can child dress unassisted? Undress? Right or Left handed? Additional Information: walkingBehavior Habits Does child follow daily routine? How does child react to change in routine? What time does child eat breakfast? Lunch? Dinner? Naptime? How Long? Bedtime: talking: *Awakes at what time? Does your child pull up? *Crawl? *Walk with supportsleep well? Any special fears? What causes child to show temper? What methods of behavior control are used in your home? Frequent colds? Runs high fever easily? History of ear problems (infections, tubes, etc.) Ever had a seizure? If so, explain: Have you suspected or detected any speech difficultiesproblems? Special words to describe needs Please check any and all that apply: ❏ Hearing Problems Wears hearing aids? ❏ Vision Problems Wears corrective lenses? ❏ Food Allergies ❏ Downs Syndrome ❏ Eczema ❏ Concussion ❏ Speech/Language spoken at home *Any history of colic? *Does your child use pacifier or suck thumb? *When? *Does your child have Delay ❏ Motor Development Delay ❏ Sensory Processing Challenges ❏ Autism Spectrum Disorder ❏ Asthma (Asthma Action Plan from a fussy time? *When? *How do you handle this time? HEALTH Any known complications at birth? Serious illnesses and/or hospitalizations: Special physical conditions, disabilities: Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions: Regular medications: EATING HABITS Special characteristics or difficulties: *If infant doctor is on a special formula, describe its preparation in detail: Favorite foods: Foods refused: * Is your child fed held in lap? High chair? * Does your child eat with spoon? Fork? Hands? TOILET HABITS *Are disposable or cloth diapers used? *Is there a frequent occurrence of diaper rash? *Do you use: oil: powder: lotion: other: *Are bowel movements regular? How many per day? *Is there a problem with diarrhea? Constipation? *Has toilet training been attempted? *Please describe REQUIRED if any particular procedure to be used for your child at the center: *What medication is used at hometo manage asthma.) ❏ Any other disease, illness, or diagnosis that would affect his/her Sonshine School day ❏ None of the Above If any boxes above are checked, please provide additional information here: Any hospitalizations or injuries in the past year? PottychairIf so, what? Special child seatAny medications prescribed for long-term or continuous use? Regular seatIf so, what? *How does your child indicate bathroom Children with special needs (include special words): _ Is your child ever reluctant due to use challenging or limiting conditions will be required to submit care recommendations from a qualified specialist prior to admission to the bathroom? _ Does your child have accidents? *Does your child sleep in a crib? Bed? Does your child become tired or nap during the day (include when and how long)?Sonshine School program.