Rhema Child Development Center - Disenrollment Form

Child/Teacher Information Form

Child's Name
Nick-Name
Date of Birth
Parents
Mom
Mobile
Home Phone
Work Phone
Dad
Mobile
Home Phone
Work Phone
Siblings
Name
Age
Name
Age
Name
Age
Other family members that reside in the home:
Child's Information
Favorite Toy
Favorite things to do
Does your child sleep on his/her back, side, or tummy?
Does your child have a sleep enhancer (doll, etc.)?
Food Dislikes
Allergies
Ongoing Medication
Fears
What special thing do you do to comfort your child when he/she is crying?
Additional information that affects your child's behavior:
Thank you for helping the RCDC staff know your child better!