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Anaphylactic Allergy Plan
Child’s Medical Needs Form
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Authorization OTC Skin Products
Authorization for Prescription Medication
Contact
2965 Hwy 43, Kemptville
+1-613 258-1931
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Home
Our School
About Montessori
Programs
Infant Program
Toddler Program
Casa Program
Kindergarten Program
Before & After Care Program
Forms
COVID Response Plan
Admission Form
Student Questionnaire
Media Release Form
Bag Lunch Policy
Tuition Fees
Emergency Record Form
Anaphylactic Allergy Plan
Child’s Medical Needs Form
Support Plan (ISP) for Special Needs
Authorization OTC Skin Products
Authorization for Prescription Medication
Contact
Student Questionnaire
* Please note that all information given on this form will remain confidential
Student Information
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Last Name
*
First Name
*
Date of Birth Student
What form of child care has your child had previously? Please explain.
Does your child nap during the day? If so, at what time and for how long?
What signs of fatigue does your child exhibit?
Does your child have any dietary restrictions? If so, explain.
What signs of hunger does your child exhibit?
Has your child had group play experiences? If so, where and how often?
What are your child’s favourite indoor and outdoor activities?
Does your child experience any separation anxiety?
Does your child dress him or herself at home?
How do you discipline your child?
Is your child left or right handed?
Is your child toilet trained?
How would you describe your child’s personality?
What areas would you like to see your child’s potential more fully developed?
What past illnesses has your child had? At what age?
Chicken Pox
Mumps
Hepatitis
Scarlett Fever
Measles
Chicken Pox Age
Mumps Age
Hepatitis Age
Scarlett Fever Age
Measles Age
Any complications?
Has your child had any serious accidents? Explain.
Does your child have allergies? If so, to what and how do they normally manifest themselves?
Does your child have frequent:
Tonsilitis
Ear Aches
Stomach Aches
Nose Bleeds
Colds
Please explain.
Does your child have any learning, behavioural or developmental needs?
Any other comments that you feel will assist us in the care of your child?
Please provide us the names and birthdays of parents, grandparents, siblings and other household members