EDUCARE INFORMATION SHEET 1801 Union Street - Niskayuna, NY 12309 (518) 382-8225
Complete this form, print it out ('File', and 'Print' on your browser) and submit this as part of your registration packet to the school office.
		Child's Name: (Last, First, Middle, Nickname)
SSN:				Birth Date:
Address:
City:				State / Zip:
Mother's Name:				Father's Name:
Business Phone:				Business Phone:
Business Address:				Business Address:
Physician's Name:				Phone:
Siblings Name / Age:
Other Members of the Household:
Proof of immunizations:
		Does your child have any specific fears (animals, darkness, and thunder)?
		What are your child's specific interests (e.g. puzzles, books, and blocks)?
		Describe any major changes in your family (e.g. divorce, seperation, birth, and death)?
		Does your child have a pet? If yes, kind / name:
		Can your child manage alone in the bathroom? YesNo		Does your child regularly nap? YesNo If yes, how long?
		Does your child have any food dislikes? YesNo		Does your child have any allergies? Yes (If yes please list - mention reaction)No
		Describe your child's disposition (cheerful, even tempered, whiny, sensitive, aggressive, etc):
		Has your child had other group experiences? YesNo		How does your child communicate his/her needs?
		How do you reward your child?		Religious affliation: (Parish)
				School District:
				Any additional information that may be helpful? Please explain on the back.