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Infant Intake Form
Welcome to Allegro! These forms are for us to learn more about your child, your family and how we can help you get the most out of your experience here. Thank you for choosing Allegro for these next steps in your child’s journey.
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Child’s full name
Your answer
Child’s age
Your answer
How would you describe your child’s temperament?
Your answer
What sort of toys/games/activities does your child enjoy?
Your answer
What do you do to soothe your child?
Your answer
How do you feel about messy play including paint, play-dough, mud, edible foods?
Your answer
Have you introduced your child to all foods?
If no please fill out a feeding guide.
Yes
No
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Does your child eat independently or need support?
Yes
No
Needs support
Occasionally needs support
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Does your child use utensils, fingers, drink from bottles and/or sip cups?
Yes
No
Occasionally
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Pandemic Questions
Has your child shown any signs of this virus during the Pandemic? If so what measures were taken?
Your answer
During this Pandemic, were you still working outside the home, if so who was caring for your child/ren?
Your answer
Where and how much or little has your child/ren been sleeping?
Your answer
Has there been any changes in your child/ren eating?
Your answer
Has your child been taking bottles if so how many a day and how many ounces? Are you using formula or milk?
Your answer
Please describe your families routine during this time.
Your answer
What other information would you like to share with us during this difficult time
Your answer
Agree to the pandemic procedures
I have read the new Pandemic Procedures and Protocols Manual, understand and adhere to all the changes that will be implemented during this challenging time. Please return this signed page to
Allegro@eastlink.ca
Sign with Name and initials below
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