Working with Outcomes
Building relationships, attachment and trust
Cultural diversity
Dear parents/carers,
To assist us in our programming and to ensure the program reflects cultural diversity, we would appreciate your help by completing this questionnaire.
Your child's name:
Does your child's name have a significant meaning?
Cultural background/s:
Language/s spoken at home:
Are there any specific cultural events, festivals and customs you celebrate? (please include dates)
Are there any specific cultural music, costumes that are used at festivals and outings you attend?
Any other relevant information that you feel may help us in our programming?
Are there any ways in which you can be involved to help us and the children to develop a wider understanding of your culture? (eg read a story, wear a cultural costume, play a cultural instrument or provide a tape or CD of cultural music for our use)
Thank you for your help
Kurrajong Room Staff
KURRAJONG ROOM
CARE AND ROUTINE INFORMATION SHEET
CHILD'S NAME:
DATE OF BIRTH:
DAYS IN CARE:
PRIMARY CARE-GIVER:
FEEDING
Has your baby had any feeding problems?
If yes, what are they?
Does your baby have a good appetite?
What is your baby eating now?
Vegetables
Cereals
Fruits
Meats
What are your baby's favourite foods?
Does your child use: Spoon? Fork? Cup with/without lid?
Is your baby breast fed?
Bottle fed?
If bottle fed, does your baby drink… Cow's milk Soy milk Formula
How often is the bottle given?
If formula, which brand?
Which strength?
DOES YOUR BABY HAVE ANY ALLERGIES TO FOODS?
If yes, what are they?
HEALTH
Has your baby had any serious illnesses?
If yes, please describe
Has your baby had any operations?
If yes, please describe
Is your baby allergic to any medications?
If yes, please describe
Is your baby allergic to Panadol?
Is your baby allergic to sunscreen?
Is your baby allergic to inset repellent?
Does your baby have any other allergies? Please explain
STAFF TO EXPLAIN CENTRE'S MEDICATION POLICY AT THIS POINT
Immunisations — dates
Triple Antigen (Dip, Tet, Whoop) 2 mths 4 mths
6 mths 18 mths
Measles/Mumps/Rubella 12 mths
Polio 2 mths 4 mths 6 mths
Other
Does your baby have any birthmarks
If yes, please describe
SLEEPING
What is your baby's sleeping pattern?
At what times does your baby usually sleep?
How long are your baby's' sleeps during the day?
How long does your baby sleep at night?
How do you usually settle your baby to sleep?
Does your baby usually cry when going to sleep?
If yes, for how long?
Has your baby had any sleeping problems?
If yes, please describe
Does your child use a dummy?
If yes, when?
PLAY
What are your baby's favourite activities?
What are your baby's favourite toys?
What are your baby's favourite songs or rhymes?
Our thanks go to Lady Gowrie Child Centre for permission to use this material. For the full context in which this material was used, see http://www.sacsa.sa.edu.au/