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Parents questionaire – kindergarten
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Parents questionaire – kindergarten
Parents questionaire – kindergarten
2024-10-20T20:32:40+02:00
New ID: 1
Personal information about the child
First and last name
Date of birth
City and country of birth
Sex
M
F
Information about the family
First and last name of the mother
Cellphone number
First and last name of the father
Cellphone number
Pegagogic data of the child
The child has been taken care of until now by
parents
grandparents
someone elste (nanny)
If someone else - who?
Child has attended an educational institution
Yes
No
If Yes - which one?
What was the adaptation period like?
Child detaches from the close persons
with difficulties
without major difficulties
never had to detach before
Medical and developmental status of the child
Pregnancy
normal
risky
rest
with medications
other
If other - explain
Week of birth
Birth type
natural
caesarean section
vacuum
other
If other - explain
Weight at birth
Length at birth
APGAR
Child status during and after the birth
normal
infections
wrapped umbilical cord
intracranial bleeding
receiving oxygen
incubator
other
If other - what
Child's pediatrist
Child's dentist
Medical insurance number (from child's health card)
The child has recovered by now
chicken pox
scarlet fever
measles
others
If other - what
Does the child suffer from a chronic disease?
Yes
No
If Yes - which one?
Does the child need regular therapy and which one?
Je li dijete doživjelo do sada kakvu traumu (traumu glave ili nesvjesticu)?
Yes
No
If YES, are there any consequences related to the trauma?
Does the child have any other health problems or conditions (e.g. febrile convulsions, epilepsy, malformations of the urogenital tract, injuries and operations, diseases of the endocrine system, cardiac or something else)
Does the child have appropriate documentation regarding a chronic disease / condition / disability?
Yes
No
If Yes - which one?
Food allergies
Yes
No
If YES, state which food the child is allergic to and how the allergy manifests itself
Medicine allergies
Yes
No
If YES, state which medicines the child is allergic to and how the allergy manifests itself
Other allergies and how the allergy manifests itself
Has the child been in the hospital?
Yes
No
If YES - why?
How do you lower a child's elevated body temperature
Do you agree that we give your child, in case of an elevated body temperature, medicine to lower the temperature?
Yes
No
Koristi li dijete usluge
speech therapist
psychologist
physiotherapist
rehabilitator
someone else
The needs and habits of the child
Child is
not breastfed
was breastfed
still beeing breastfed
If child was breastfed, for how long (months)
How independent is the child when drinking
drinks from a bottle
drinks with help from a cup
drinks from a cup independently
How independent is the child when eating
Child
refuses some food
eats chopped
eats only mixed food
feeding rituals
something else
If the child refuses some food - which one
If feeding rituals - explain
If something else - explain
Does the child need an afternoon break?
Yes
No
If YES, how does the child rest (sleeps; lies down, but does not fall asleep; rests with a picture book)
Does the child have difficulty sleeping? If Yes - explain
Time of daytime sleep (if the child sleeps)
How the child falls asleep
breastfeeding
with a bottle or on a pacifier
with a favorite toy
by carrying it on the hands
something else
If something else - explain
Is the child currently wearing diapers?
yes, all the time
yes, for daytime sleep
yes, for sleeping at night
no
If the child is weaned from diapers, does it occur
urinating in panties while awake / sleeping, how often
soiling panties with stool, how often
stool retention
something else
Please explain
Play and interests of the child
Experiences in playing with peers
everyday
occasional
very small
prefers the company of adults
without experience with peers
prefers to play alone
A child is playing with other children
actively
just observes
does not participate at all
In situations of conflict, the child
fights for himself (takes / pushes / fights / argues / agrees)
does not stand up for himself (cries / screams / asks an adult for help / withdraws / sulks)
How long can a child spend in independent play?
What game is that
The child shows interest in
research, active familiarization with the environment, handling objects, toys: turning, shaking, throwing, inserting, assembling, disassembling
learning about concepts from the immediate and wider environment, animals, plants, toys
letters, numbers
putting together puzzles
construction: cube tower, train, houses, garages
imitation of seen actions: talking on the phone, combing, feeding a doll, role-playing games, doodling, drawing, painting
games with water, sand, plasticine
looking at picture books, listening to stories, recounting events, stories
listening to music, singing songs, acting
foreign languages
games with movement: walking, running, jumping, climbing, crawling, riding a tricycle, bicycle, dancing
something else
What are child's favourite toys?
What are child's favourite games?
What are child's favourite objects?
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