Booking Now Early Childhood Essentials is a “private teaching” platform designed for the “individual” learning needs of young children from 3 to 8 years of age Url Childs Name * Date of Birth Current Playgroups/Schools Attending Parent’s / Guardian’s Name Address Contact Details Phone Mobile Email Does your child have any known emotional or behaviour issues? (If yes, please state in brief) Does your child have any known / severe allergies? Does your child have asthma? Is your child taking any medications? If yes, please provide details Please complete the following to the best of your knowledge and discuss any specific concerns you have directly with me so that together we may best support your child. Ability to be calm & peaceful at times Excellent Good OK Needs Extra Needs lots of Support Support Ability to deal with anxiety & stress Excellent Good OK Needs Extra Needs lots of Support Support Ability to express their feelings Excellent Good OK Needs Extra Needs lots of Support Support Self-esteem & self - confidence Excellent Good OK Needs Extra Needs lots of Support Support Ability to cope with feelings of anger Excellent Good OK Needs Extra Needs lots of Support Support Ability to openly show care & concern for themselves and others Excellent Good OK Needs Extra Needs lots of Support Support Attention Span Excellent Good OK Needs Extra Needs lots of Support Support Ability to Listen Excellent Good OK Needs Extra Needs lots of Support Support Sleep Patterns Excellent Good OK Needs Extra Needs lots of Support Support Please state your learning goals for your child Additional information How did you hear about Early Childhood Essentials? Please acknowledge that you have read the Terms & Conditions for payments of classes. *
