Professional Documents
Culture Documents
Child's Profile SUNSHINE
Child's Profile SUNSHINE
3. Sex Male Female 4a. Birth Order* 4b. No. of Siblings* 5a. Date of Birth*
YYYY - MM - DD
7. Home
Address
No. & Street Address Barangay* City / Municipality* - Province* Region*
8. Religion 9. Ethnicity
12. The child underwent the following: (check all applicable and fill details.) 13. The child has the following disabilities/ Impairments
A. Disability/Impairment (e.g. hearing, speech ,visual) b.Cause (e.g.newbornillness
Breastfeeding – breastfed for
1.
months 2.
Supplemental Feeding- supplemented for 3.
4.
Days 5
6.
Food for School (Ree Distribution) – weekly allotment of 14. The child has the following past ECCD experiences:
a. Service Type* b. Service* c. From (Start Date) d. To (enddate)
kg
(e.g. Center, community) (e,g Child Minding, (YYYY.MM.DD) (YYYYMMDD)
Assessment or assistance for a Disability from: care mother)
Others:
___________________________________
15a. Participants Fee 16. Schedule*
Page1
Rev. 01.18.09 Profile ID (copy from 1* page)
Republic of The Philippines
Department of Social Welfare and Development
Child Information Sheet
Early Childhood Care and Development
V. Health Services: Have the Health Service Provider sign beside each entry (use additional sheets as necessary )
Page 2
PARENT INTERVIEW FORM/INTAKE
No. of the Family Members _______________
1) Gaano katagal ang oras at panahon na ginugugol mo para sa iyong anak araw-araw?
__________________________________________________________________________________________
2) Anu-anong patakaran sa bahay ang dapat sinusunod ng iyong mga anak
__________________________________________________________________________________________
3) Anu-anong mga pamamaraan ang pagdidisiplina ng iyong anak?
__________________________________________________________________________________________
_____________________________________________________________________________________________________
___________________________________________________________________________
4) Nong mga balakid o sagabal ang iyong naranasan sa pagdidisiplina ng iyong anak?
__________________________________________________________________________________________
5) Kung mayroon man, paano mo ito binibigyan solusyon?
_____________________________________________________________________________________________________
_______________________________________________________________________________
6) Ilang oras ba ginugugol ng iyong anak sa panonood ng TV? ________________________________________
Sino ang sumusubaybay sa kanya sa panonood nito? ____________________________________________
7) Mayroon bang kinakatakutan ang iyong anak? _________________________________ Kung mayroon man,
Ano ang mga iyon _________________________________________________________________________
________________________________________________________________________________________
8) Nagkaroon nab a ng hindi inaasahang pangyayari sa buhay ng iyong anak? Halimbawa, aksidente, malubahang sakit, etc.
_______________________________________________________________________
__________________________________________________________________________________________
9) Anong allergies o gamut ang puedeng ibigay sa anak mo kung nilalagnat?
__________________________________________________________________________________________
10) Sa palagay, mo, mayroon bang kakaibang problema o pangangailangan ang iyong anak na nangangailangan ng espesyal
na atensiyon? ________________________________________________________________ kung mayroon man, ano ang
mga iyon? ______________________________________________________________
__________________________________________________________________________________________
11) Anu-ano ang mga rason/dahilan bakit gusto mong ipasok at pag-aralin ang iyong anak sa paaralang ito?
__________________________________________________________________________________________
12) Anu-ano ang iyong mga inaasahan na matutuhan at malalaman ng iyong anak sa pagpasok sa paaralang ito?
______________________________________________________________________________________
13) Interesado ka bang dumalo sa study group meeting para lalong matuto tungkol sa Montessori Approach Education at
ECCD _____________________________________________ ilang oras ba ang maari mong ilaan?
_____________________________________________________________________________________
14) Anong uri ng pakikipag-ugnay ang iyong inaasahan mula sa paaralan at sa iyong tahanan?
__________________________________________________________________________________________
__________________________________________________________________________________________
15) Anu-anong pang mga bagay ang iyong iminumungkahi para sa kabutihan ng iyong anak at paaralan?
__________________________________________________________________________________________
EMERGENCY CONTACT:
Names TELEPHONE/ADDRESS
_________________________________________ _____________________________________________
_________________________________________ _____________________________________________
Page 3
KASUNDUAN
Ang mga sumusunod na alintuntuning nauukol sa mga magulang ng batang sumali sa programa:
1. Nararapat na malinis ang katawan, ngipin at pananamit ng mga bata sa araw-araw pagpasok
sa paaralan.
2. Kailangang dumalo sa mga pulong ukol sa mga magulang at guro minsan isang buwan at kung
mayroong di pangkaraniwang pangyayari o panayam.
8. Bilang competent partners, kailangang isangguni sa Day Care ang anumang mungkahi, suliranin
O problema patungkol sa Day Care Service program upang mapag-usapan.
Sang-ayon:
______________________
Pirma ng Ina
______________________ ___________________________
Pirma ng Ama Pirma ng Guro
______________________ ______________________________
Petsa Pirma ng DAYCARE Supervisor
Page 4
BIRTH CERTIFICATE
Page 5
BCYW-DCS Form No. 5
____________________________
Signature of Physician
______________________________
Date
Page 6
Growth Monitoring Chart
Page 7
SCHOOL HEALTH EXAMINATION CARD
DETENTION STATUS AND TREATMENT NEEDS TREATMENT RECORD
Date Toot Nature of Dentist
STATUS h No Operation
LEFT
RIGHT
TEMPORARY TEETH
STATUS
TREATMENTTEMPORARY
NEEDS TEETH
RIGHT LEFT
Status
Page 8
It is recommended that the Checklist be administered to the child once a year
Page 9
GROSS MOTOR DOMAIN ECCD CHECK LIST
Gross Motor Present Comments
1st Eval. 2nd Eval. 3rd Eval.
1. Climbs on chair or other elevated piece of
furniture like a bed without help.
2. Walks backwards
3 .Run without tripping or falling
4. Walks downstairs,. 2 feet of each step, with
one hand held
5. Walks upstairs holding onto handrail, 2 feet o
each step
6. Walk upstairs with alternate feet without
holding onto a handrail
7. Walks downstairs with alternate feet without
holding onto a handrail
8. Moves body part as directed
9. Jumps up
10. Throws ball overhead with direction
11. Hops 3 steps on preferred foot
12. Jumps and turns
13. Dances patterns/joins group movement
activities
TOTAL SCORE
SELF-HELP DOMAIN
Self-Help Present Comments
st nd rd
1 Eval. 2 Eval. 3 Eval.
1 Feeds self with finger food (e.g. biscuits, bread)
using fingers
2 Feeds using fingers to eat rice/viands with spillage
3 Feeds self using spoon with spillage
4 Feeds self using fingers without spillage
5 Feeds self using spoon without spillage
6 Eats without need for spoon feeding during any
meal.
7 Helps hold cup of drink
8 Drinks from cup with spillage
9 Drinks from cup unassisted
10 Gets drink for self unassisted
11 Pours from pitcher without spillage
12 Prepares own food/snack
13 Prepares meats foe younger siblings/family
members when no adult is around.
Dressing Domain
14 Participates when being dressed (e.g. raise arms
or lifts leg)
15 Pulls down gartered shorts pants
16 Removes sando
17 Dresses without assistance except buttoning and
tying
18 Dresses without assistance, including buttoning
and tying
Toilet Training sub-domain
19 Informs the adult only after he has already
urinated (peed) or moved his bowels (poohed) in
his underpants
20 Informs the adult need to urine (pee) or move
bowels (pooh-pooh) so he can be brought to a
designated place (e.g. CR)
21 Goes to the designated place to urine (pee) or
moves bowels (pooh) but sometimes still does
this in underpants
22 Goes to the designated place to urine (pee) or
move bowels (pooh) and never does this in his
underpants anymore
23 Wipes/cleans self after a bowel movement (pooh)
24 Participates when bathing (e.g. rubbing arms with
soap )
25 Washes and dries hands without any help
26 Washes face without any help
27 Bathes without any help
TOTAL SCORE
Page 11
Page 12
COGNITIVE DOMAIN
Cognitive Language Present Comments
1st Eval. 2nd Eval. 3rd Eval.
1 Looks to the direction of a fallen object
2 Looks for a partially hidden object
3 Imitates behaviour just seen a few minutes earlier
4 Offers an object but may not release it
5 Looks for a completely hidden object
6 Exhibits simple “pretend ” play (i.e. puts doll to
sleep)
7 Matches objects
8 Matches 2 to 3 colors
9 Matches pictures
10 Sorts based on shapes
11 Sorts objects based on attributes (e.g. size and color)
12 Arranges objects according to size from smallest to
biggest
13 Names 4 to 6 colors
14 Copies shapes
15 Names 3 animals or vegetables when asked
16 States what common household items are used for
17 Can assemble simple puzzles
18 Demonstrate an understanding of opposites by
completing a statement (e.g. “Ang aso ay malaki,
and daga ay ___________.”)
19 Points to left and right sides of body
20 Can state what is silly or wrong with pictures (e.g.
Ano ang mali sa larawang ito?)
21 Matches upper case letters; and matches lower case
letters
TOTAL SCORE
Page 13
SOCIAL-EMOTIONAL DOMAIN
Social-Emotional Language Present Comments
1st Eval. 2nd Eval. 3rd Eval.
1 Enjoys watching activities of nearby people or
animals
2 Friendly with strangers but initially may show slight
anxiety or shyness
3 Plays alone but likes to be near familiar adults or
brothers and sisters
4 Laughs or squeals aloud in play
5 Plays peak-a-boo (bulaga)
6 Rolls ball interactively with caregiver/examiner
7 Hugs or cuddles toys
8 Demonstrates respect for elders using terms like
“po” and “opo”
9 Share toys with others
10 Imitates adult activities (e.g. cooking, washing)
11 Identifies feelings in others
12 Appropriately uses cultural gestures of greeting
without much prompting ?(e.g. mano, bless, kiss,
etc.)
13 Comforts playmates /siblings in distress
14 Persists when faced with a problem or obstacles to
his wants
15 Helps with family chore (e.g. wiping tables,
watering plants, etc.)
16 Curious about environment but knows when to
stop asking questions of adults
17 Waits for his turns
18 Asks permissions to play with toy being used by
another
19 Defends possessions with determination
20 Plays organized group games fairly (e.g., does not
cheat to win)
21 Can talk about complex feelings (e.g., anger,
sadness, worry) he experiences
22 Honors a simple bargain with caregiver (e.g., plays
outside only after cleaning/fixing his/her room)
23 Watches responsively over younger siblings/family
members
24 Cooperates with adults and peers in group
situations to ominimize quarrels and conflicts
TOTAL SCORE
Page 14
Transfer the raw for each domain to the table below. Using the Scaled Score Equipment of Raw
Scores Table, convert the raw scores to Scaled Scores appropriate to the age of the child. To
arrive at the sum of the scaled scores, add the scaled scores across all domains. To derive the
Standards Score Equipment of Sums of Scaled Scores Table. Write the child’s age on each
evaluation.
A G E
Domain 1st Eval. Date: ________
Child’s Age: _________
2nd Eval. Date: ________
Child’s Age: _________
3rd Eval. Date:
________
Child’s Age:
_________
Raw Score Scaled Score Raw Score Scaled Score Raw Score Scaled
Score
Gross Motor
Fine Motor
Self-Help
Receptive
Language
Expressive
Language
Cognitive
Social-Emotional
Sum of Scaled
Scores
Standard Score
Interpretation
Page 15
SCALED SCORES
Mark an x on the dot corresponding to the Scaled Score for each domain and connect the
x’s. Write the child’s age on each evaluation.
EXPRESSIVE LANGUAGE
EXPRESSIVE LANGUAGE
EXPRESSIVE LANGUAGE
SOCIAL-EMOTIONAL
SOCIAL-EMOTIONAL
SOCIAL-EMOTIONAL
MOTOR
MOTOR
MOTOR
FINE MOTOR
FINE MOTOR
FINE MOTOR
COGNITIVE
COGNITIVE
COGNITIVE
SCALED
SCALED
SCALED
RECEPTIVE
RECEPTIVE
RECEPTIVE
LANGUAGE
LANGUAGE
LANGUAGE
SELF-HELP
SELF-HELP
SELF-HELP
SCORE
SCORE
SCORE
GROSS
GROSS
GROSS
19 . . . . . . . 19 . . . . . . . 19 . . . . . . .
Suggests advanced
18 . . . . . . . 18 . . . . . . . 18 . . . . . . .
Development
17 . . . . . . . 17 . . . . . . . 17 . . . . . . .
16 . . . . . . . 16 . . . . . . . 16 . . . . . . .
15 15 15
. . . . . . . . . . . . . . . . . . . . .
14 14 14
. . . . . . . . . . . . . . . . . . . . .
13 13 13
. . . . . . . . . . . . . . . . . . . . .
12 12 12
11
. . . . . . . 11
. . . . . . . 11
. . . . . . .
. . . . . . . . . . . . . . . . . . . . .
development
10 10 10
Average
9
. . . . . . . 9
. . . . . . . 9
. . . . . . .
8 . . . . . . . 8 . . . . . . . 8 . . . . . . .
7 . . . . . . . 7 . . . . . . . 7 . . . . . . .
6 . . . . . . . 6 . . . . . . . 6 . . . . . . .
5 . . . . . . . 5 . . . . . . . 5 . . . . . . .
Re-test after 3 to 6
4 . . . . . . . 4 . . . . . . . 4 . . . . . . .
3 . . . . . . . 3 . . . . . . . 3 . . . . . . .
2 . . . . . . . 2 . . . . . . . 2 . . . . . . .
1 1 1
. . . . . . . . . . . . . . . . . . . . .
months
. . . . . . . . . . . . . . . . . . . . .
Page 16
STANDARD SCORES
Mark an x on the corresponding Standard Score for each test administration and
connect the x’s. Write the date for each test administration.
A G E S
3 years & 1 month 4 years 5 years
________
160
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
________ ________ ________
Date Tested
Page 17
Page 18
Growth Chart
Record Informationalong the month-of-weighing line using the symbols below:
W - Weight
F - Fever
B - Breastfeeding
C - cold/cough
C/F - complementary foods introduced
D - diarrhea
OI - other illness
A - Vitamin A given
H - hospitalized
I - signs of injuries such as
Abrasions/hematoma
4 – 5 years
3 – 4 years 4 – 5 years
61 62 63 64 65 66 67 68 69 70 71 72
49 50 51 52 53 54 55 56 57 58 59 60
*+SD – Standard
37 38 39 40 41 42 43 44 45 46 47 48
Age in Months
Month of Weighing
The child’s weight should be between the A Child who is ... A child who is...
“reference” curves. The plotted growth curve Not gaining weight has plotted growth Losing weight has a plotted growth curve that goes in
should go in upward direction. curve that flattens off or looks like a flat a downward/declining direction between the
line between the “reference” curve. “reference” curves.
Page 19
Page 20
Throws ball overhead Baths Unassisted Recounts recent Matches upper and Uses cultural gesture or
with direction experiences in order lower case letter greeting without
of occurrence using prompts (e.g. mano,
past tense bless, kiss)
months
4 years
Draws a human figure or Uses toilet with Ask “WHAT”,”WHO” Arranges objects Play organized group
house occasional accidents and “WHY” questions according to size from games fairly
smallest to biggest
months
3 years
Runs without tripping Pulls down gartered Speak grammatically Matches objects and Imitates adult activities
shorts correct 2-3 words pictures (e.g., cooking, washing)
months
2 years
Holds crayons with Drinks from cup with Names objects in Exhibits simple pretend Rolls ball interactively
palmar grasp; Scribbles spillage pictures play (e.g., feed, put doll with caregiver
Spontaneously to sleep)
months
1 years & 6 months
Walks alone, rarely falls Feed self using spoon Combines single words Searches for complete Friendly with strangers
with spillage and gesture to make concealed object but initially, shows
wants known (e.g., anxiety or shyness
“out”)
months
1 years
Stands with minimum Feeds self with fingers Uses meaningful Looks at direction of Cries when caregiver
support (biscuit, bread) sounds to refer to fallen object leaves
specific objects or
persons (e.g., “mama”,
“dada”)
months
Sit alone steadily Begin to take solid Turns head when Explores objects by Enjoys friendly handling
foods called by name, make biting or holding
eye contact
months
Holds head steadily Sucks and swallows Turns head toward Gazes slowly at mocing Smiles and lifts arms to
liquid sound objects great careguver
Ensure the best possible start in your child’s life. Monitoring your child’s development
Page 21
OBSERVATION NOTES
Page
22
OBSERVATION NOTES
```
Page 23
INDIVIDUAL PARENT CONFERENCES
Page 24
INDIVIDUAL PARENT ‘S CONFERENCES
HOME VISITATION
Page 27
Dental Referral Form
OFC Referral Slip
Republic of the Philippines
Province of Catanduanes
Municipality of Bato
BARANGAY ____________
REFERRAL SLIP
DATE : _____________
__________________________
NAME OF CDW
- - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - ------- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Dental Referral Form
OFC Referral Slip
Republic of the Philippines
Province of Catanduanes
Municipality of Bato
BARANGAY ____________
TO : MR/MRS. : ___________________________
CHILD DEVELOPMENT CENTER : ___________________________
This is to inform you that ______________________________ , ______________ years old, was admitted at this
clinic and upon oral examination was found to have the following findings :
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
TREATMENT DONE :
1. ______________________________________________________________________________
2. ______________________________________________________________________________
3. ______________________________________________________________________________
REMARKS : ___________________________________________________________________________
______ ___________________
Public Health Dentist
Page 28
ACCIDENT OR INCIDENT REPORT
INSTRUCTION :
Accomplish this form for any significant occurrence such as accident or unusual
problem or situation that may affect the physical, emotional , and psychological
condition of the child.
EXPLANATION :
_______________________________________________________________________
_______________________________________________________
___________________________________________________________
___________________________________________________________
ACTION TAKEN :
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
COMMENTS :
_______________________________________________________________________
_______________________________________________
___________________________________________________________
REPORTED BY :
_______________________ ________________________
( Name & Signature ) (Signature of CDW)
Page 29
DATE/MONTH CHILD NARRATIVE PROGRESS REPORT
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
MARCH
APRIL
MAY
Page 30
CHILDREN’S MONITORING
DOMAIN RATING DOMAIN RATING
GROSS MOTOR 1st 2nd 3rd 4th 1st 2nd 3rd 4th
1. Runs without tripping Numeracy
2. Jumps in place with both feet 1. Points out which has more or less
3. Hops 1 to 3 steps on preferred foot 2. Counts up to 10 objects
4. Skips with alternate feet 3. Sequence numeral 1 - 10
5. Moves body parts as directed 4. Identify the missing number in sequence
6. Throws ball overhead with direction 5. Adds and subtracts combinations to 10
FINE MOTOR Reading Readiness
1. Holds crayon/pencil and scribbles spontaneously 1. Identifies the missing part of picture/object
2. Scribbles vertical and horizontal lines 2. Recites or sings the alphabet
3. Draws a human figure 3. Names upper and lower case letters
4. Draws a house 4. Matches letter without sound of letter
5. Colors within a line 5. Read 3-4 letter words
RECEPTIVE/EXPRESSIVE LANGUAGE 6. Sequence events and picture
1. Answers question about oneself 7. Identifies pictures that are the same
2. Uses simple greetings and courteous expressions 8. Identifies letters that are different
in appropriate situations 9. Identifies words that are the same
3. Follow one-step direction with simple prepositions 10. Associates word with picture
(e.g., in, on, under) Construction and Visual-Motor Integration
4. Follows two-step directions in identifying objects 1. Replicates a pattern by drawing
in term in position 2. Copies letter/numeral from model
5. Names 4-6 colors 3. Identifies the missing object in given pattern
COGNITIVE 4. Identifies the picture that give the
Sensory Discrimination and Seration/Classification appropriate ending of events/situation
1. Discriminates texture 5. Assembles simple puzzles
2. Arrange objects according to size from smallest TOTAL MASTERED SKILLS/DOMAIN
to biggest
3. Sorts objects based on two attributes READY (Y) Yes (N) No
4. Identifies same and different shapes
5. Draws geometric forms NOTE: Passing score is 34 which is 75 of the highest possible score (45).
Concept Formation A child who got the score of 34 and above is “READY” while the child
1. Groups and states functions of common house- with the score of 33 and below is considered as “NOT READY” to
hold items perform Grade work. (Checklist for Character Traits is not include in the
2. Shows/points to left and right side of body computation)
3. Completes statements showing simple analogy INSTRUCTION: When the child exhibits the skill, put a check in the
4. Identifies absurdities in pictures (e.g., Ano ang mali corresponding skill. Put a Hypen (-) if the child cannot perform the task.
sa larawang ito?) REFERRENCE: School Readiness Assessment (SReA) Tool.
5. Conserves number
Page 28
CHARACTER TRAITS
1 Love of God – demonstrates love of God, parents elder
and other.
2 Love of Country – demonstrates love and pride of one’s
country.
3 Respect for Parents, elders, and Others – demonstrates
love for parents, elders and others.
4 Courtesy and Politeness – be able to gesture that show
respect for others.
5 Appreciates of one’s Culture – exhibits love of Filipino
Culture.
6 Social Responsibility – demonstrates cares and concern
for others.
7 Love of Work – demonstrates proper use of one’s
resources.
8 Sportsmanship – display good conduct in times of victory
and defeat in any kind of competition.
9 Cleanliness and Orderliness – demonstrates proper ways
of good grooming and tidiness.
10 Care of One’s Surroundings – demonstrates concern for a
clean and orderly dwelling place.
11 Care of Environment – practice of conversation of
environment through proper care of living things.
12 Thriftiness – practices wise use and conversations of one’s
resources.
13 Promptness – demonstrates the value of time.
Legend:
O – Outstanding
VS – Very Satisfactory
S – Satisfactory
NI – Need Improvement
Day Care is Caring for our
CHILDREN’S FUTURE
The first year of life is the most crucial stage of the child’s
growth & development. By age six (6), the child’s brain would have
already reached 90% percent of its adult weight. The care the
child gets during these formative years would significantly affect
his learning capacity, creativity, social interaction and the entire
individual’s personality.
1. Maisilang at magkaroon ng
pangalan at nasyonalidad.
7. Mabigyan ng pagkakataon na
makapaglaro at makapaglibang.
9. Maipagtangol at matulungan
ng pamahalaan.
PHOTO
SY 201___ - 201___
Republic of the Philippines
Province of Catanduanes
MUNICIPAL GOVERNMENT OF BATO
Bato, Catanduanes
PHOTO
PHOTO