Common use of General History Clause in Contracts

General History. Has your child had previous child care experiences? If yes, please list location(s) of previous child care experience:  Yes  No ____________________________________________________________________________________________________________________________________ What is your child’s favorite toy? _________________________________________________________________________________________________________ What is your child’s favorite activity? ______________________________________________________________________________________________________ How do you comfort your child? (i.e. pacifier, blanket, hugs, toy) ________________________________________________________________________________ Does your child seem healthy most of the time?  Yes  No Is your child taking any medication now? If yes, what? ________________________________ why? ________________  Yes  No In the past year, has your child had any ear infections?  Yes  No In the past year, has your child had any colds or sore throat infections with a fever?  Yes  No Has your child had trouble with his/her eyes or vision?  Yes  No What arrangements have you made for the care of your child should he/she become ill at the center? ___________________________________________________________ Does your child have any special needs that the staff should be aware of? Please attach a copy of your child IEP, if applicable.  Yes  No Is yes, explain: ________________________________________________________________________________________________________________ Does your child have, or ever had, other illnesses or diseases the staff should be aware of? If yes, list type, when and how treated.  Yes  No ____________________________________________________________________________________________________________________________________ Has your child ever been hospitalized? If yes, for what?  Yes  No __________________________________________________________________________ Has your child ever had any serious accidents or poisonings? If yes, list type, when and how treated.  Yes  No ____________________________________________________________________________________________________________________________________ Does your child have any food/environmental allergies, asthma or special food accommodations as determined by a physician  Yes  No OR preferences (such as personal preference or religious preference)  Yes  No If yes, please explain. _________________________________________________________________________________________________________________ Check any of the following your child has ever had: Seizures or convulsions  Yes  No Premature birth  Yes  No Trouble breathing at birth  Yes  No Head Injury  Yes  No Emotional Behavior Birth injury or defect  Yes  No Please indicate which word(s) you feel are most applicable for you child.  Generally Cheerful  Sensitive  Talkative  Group Leader  Cooperative  Physical  Calm  Easily Excited  Outgoing  Quiet  Group Follower  Active  Independent Player  Eager learner  Explorer  Aggressive  Possessive  Often Shy List any other comments about child’s behavior: _____________________________________________________________________________________________ What behavior do you consider most difficult to deal with? _____________________________________________________________________________________ What fears does your child have? Describe the history and how the child shows fear._________________________________________________________________ Does your child have any communication habits we should know about? _________________________________________________________________________ Is there anything you think, that we, as teachers, should know about your child to help us work with him or her more effectively/ Please include cultural preferences. _______________________________________________________________________________________________________________

General History. Has your child had previous child care experiences? If yes, please list location(s) of previous child care experience:  Yes  No ____________________________________________________________________________________________________________________________________ What is your child’s favorite toy? _________________________________________________________________________________________________________ What is your child’s favorite activity? ______________________________________________________________________________________________________ How do you comfort your child? (i.e. pacifier, blanket, hugs, toy) ________________________________________________________________________________ Does your child seem healthy most of the time?  Yes  No Is your child taking any medication now? If yes, what? ________________________________ why? ________________  Yes  No In the past year, has your child had any ear infections?  Yes  No In the past year, has your child had any colds or sore throat infections with a fever?  Yes  No Has your child had trouble with his/her eyes or vision?  Yes  No What arrangements have you made for the care of your child should he/she become ill at the center? ___________________________________________________________ Does your child have any special needs that the staff should be aware of? Please attach a copy of your child IEP, if applicable.  Yes  No Is yes, explain: ________________________________________________________________________________________________________________ Does your child have, or ever had, other illnesses or diseases the staff should be aware of? If yes, list type, when and how treated.  Yes  No ____________________________________________________________________________________________________________________________________ Has your child ever been hospitalized? If yes, for what?  Yes  No __________________________________________________________________________ Has your child ever had any serious accidents or poisonings? If yes, list type, when and how treated.  Yes  No ____________________________________________________________________________________________________________________________________ Does your child have any food/environmental allergies, asthma or special food accommodations as determined by a physician  Yes  No OR preferences (such as personal preference or religious preference)  Yes  No If yes, please explain. _________________________________________________________________________________________________________________ Check any of the following your child has ever had: Seizures or convulsions  Yes  No Premature birth  Yes  No Trouble breathing at birth  Yes  No Head Injury  Yes  No Emotional Behavior Birth injury or defect  Yes  No Please indicate which word(s) you feel are most applicable for you child.  Generally Cheerful  Sensitive  Talkative  Group Leader  Cooperative  Physical  Calm  Easily Excited  Outgoing  Quiet  Group Follower  Active  Independent Player  Eager learner  Explorer  Aggressive  Possessive  Often Shy List any other comments about child’s behavior: _____________________________________________________________________________________________ What behavior do you consider most difficult to deal with? _____________________________________________________________________________________ What fears does your child have? Describe the history and how the child shows fear._________________________________________________________________ Does your child have any communication habits we should know about? _________________________________________________________________________ Is there anything you think, that we, as teachers, should know about your child to help us work with him or her more effectively/ Please include cultural preferences. _______________________________________________________________________________________________________________

General History. Has your child had previous child care experiences? If yes, please list location(s) of previous child care experience:  
Yes  
No ____________________________________________________________________________________________________________________________________ What is your child’s favorite toy? _________________________________________________________________________________________________________ What is your child’s favorite activity? ______________________________________________________________________________________________________ How do you comfort your child? (i.e. pacifier, blanket, hugs, toy) ________________________________________________________________________________ Does your child seem healthy most of the time?  
Yes  
No Is your child taking any medication now? If yes, what? ________________________________ why? ________________  
Yes  
No In the past year, has your child had any ear infections?  
Yes  
No In the past year, has your child had any colds or sore throat infections with a fever?  
Yes  
No Has your child had trouble with his/her eyes or vision?  
Yes  
No What arrangements have you made for the care of your child should he/she become ill at the center? ___________________________________________________________ Does your child have any special needs that the staff should be aware of? Please attach a copy of your child IEP, if applicable.  
Yes  
No Is yes, explain: ________________________________________________________________________________________________________________ Does your child have, or ever had, other illnesses or diseases the staff should be aware of? If yes, list type, when and how treated.  
Yes  
No ____________________________________________________________________________________________________________________________________ Has your child ever been hospitalized? If yes, for what?  
Yes  
No __________________________________________________________________________ Has your child ever had any serious accidents or poisonings? If yes, list type, when and how treated.  
Yes  
No ____________________________________________________________________________________________________________________________________ Does your child have any food/environmental allergies, asthma or special food accommodations as determined by a physician  
Yes  
No OR preferences (such as personal preference or religious preference)  
Yes  
No If yes, please explain. _________________________________________________________________________________________________________________ Check any of the following your child has ever had: Seizures or convulsions  
Yes  
No Premature birth  
Yes  
No Trouble breathing at birth  
Yes  
No Head Injury  
Yes  
No Emotional Behavior Birth injury or defect  
Yes  
No Please indicate which word(s) you feel are most applicable for you child.  
Generally Cheerful  
Sensitive  
Talkative  
Group Leader  
Cooperative  
Physical  
Calm  
Easily Excited  
Outgoing  
Quiet  
Group Follower  
Active  
Independent Player  
Eager learner  
Explorer  
Aggressive  
Possessive  
Often Shy List any other comments about child’s behavior: _____________________________________________________________________________________________ What behavior do you consider most difficult to deal with? _____________________________________________________________________________________ What fears does your child have? Describe the history and how the child shows fear._________________________________________________________________ Does your child have any communication habits we should know about? _________________________________________________________________________ Is there anything you think, that we, as teachers, should know about your child to help us work with him or her more effectively/ Please include cultural preferences. _______________________________________________________________________________________________________________