About My Life
Child’s Name: _____________________
Youning Ji Date of Birth: _______________________
02.04.2024
The name I prefer to be called is: __________________________________________________
Iris
The most special thing about me is: ________________________________________________
The People in my Life
The special name I call my mother is: ______________________________________________
Mama
The special name I call my father is: _______________________________________________
Dada
Other special people in my life are: ________________________________________________
Grandma and grandpa
____________________________________________________________________________
My best friend’s name is: _______________________________________________________
Xiaoyu
My pet’s name is: _____________________________________________________________
Gulu
Important things to know about me
The things I enjoy doing are: _____________________________________________________
Play toys with my friends and my parents
____________________________________________________________________________
Things I do well are: ___________________________________________________________
I can crawl very fast , I like to pointing at things and I talk a lot.
____________________________________________________________________________
My favourite songs are: _________________________________________________________
2NE1 and bigbang songs
My favourite book is: ___________________________________________________________
little duck what can you see
My favourite toys are: __________________________________________________________
Jellycat rabbit and dragon
My favourite foods are: _________________________________________________________
Cherry tomatoes, corn
New things ,I need time to accept
Things that scare me are: _______________________________________________________
Focusing on toys or the thing I’m playing with
When I am calm I like to: ________________________________________________________
When I am overloaded and not happy, this helps: ____________________________________
Give me a hug and some formula, I also like my pink blanket, it makes me feel comfortable.
____________________________________________________________________________
____________________________________________________________________________
Date completed: ________________________
11.06.25
My Typical Daily Rhythm
Child’s Name: _____________________
Youning Ji Date of Birth: _____________________
02.04.2024
I DRINK
In my bottle I have: Cow's Milk | Breast Milk | Formula | Other: ______________
Time Amount
8.30am 160ml
2:00pm 160ml
20:00pm 160ml
My water intake: I drink small amounts in one sitting OR I drink large amounts in one sitting
Frequency I am offered water at home:___________________________________________
220ml
I EAT
Time Foods/ Amount
Toast
10:30am
Noddles
12:30pm
Rice and meatballs
17:00pm
I SLEEP
The best way to help me sleep is: ___________________________________________________
dragon comforter/ formula/ blanket
______________________________________________________________________________
(consider specific health care needs, requests and cultural preferences)
Time/s For How Long?
TOILETING
I need nappies: All Day | For Rest
Comments:
_____________________________________________________________________
I am toilet training and need assistance
Comments:____________________________________________________________
Not start yet
_____________________________________________________________________
I can independently use the toilet
Comments:____________________________________________________________
_____________________________________________________________________
Development & Behaviour Record
Child’s Name: _____________________
Youning Ji Date of Birth: _______________________
02.04.2024
Does your child have any concerns regarding your child’s development? YES / NO
Please advise detail and how staff need to assist:
______________________________________________________________________________
She’s learning to walk at the moment, if teachers can hold her hands that will be very helpful.
______________________________________________________________________________
______________________________________________________________________________
Has your child been assessed for hearing problems or speech delay? YES / NO
If yes, please include date and details below:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Does your child have any behavioural issues? YES / NO
If yes, please provide details or diagnosis:
______________________________________________________________________________
______________________________________________________________________________
Does your child visit specialists or therapy? YES / NO
If yes, list specialist’s names and provide staff and with current documentation and any ongoing
information form specialists for your child’s support to be based on current recommendations:
______________________________________________________________________________
______________________________________________________________________________
How do you interact with your child at home when they challenge your authority and
frustrating situations arise that you need to address?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please note we have a Family Consultant to answer questions or discuss any area of your child’s
development and routines. 1:1 sessions are available by appointment.
My Culture and Language
Child’s Name: __________________________________
Youning Ji
At Jump, we feel that incorporating child and family cultures and languages is important to a child’s
developing self-awareness. We have a variety of cultural resources. Please feel welcome to also
provide educators with any books, pictures or posters that relate to your home language and
culture and complete this survey.
What is your home and family culture:
______________________________________________________________________________
No
Countries of Birth
I was born in: ___________________________________________________________________
Australia
My Mum was born in: ___________________
China My Dad was born in: ____________________
China
Family Language
At home we speak: _______________________________________________________________
Mandarin
How does your child communicate?
If English is an additional language for your child please provide phrases and translations
educators will require during your child’s day:
Hello __________________________________________________________________________
I will be here ____________________________________________________________________
Are you ok? ____________________________________________________________________
Mum/Dad will be back soon ________________________________________________________
What could you play? _____________________________________________________________
Are you hungry? _________________________________________________________________
Do you need the toilet? ___________________________________________________________
Please provide the words of colours or numbers in your home language:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Child Goals
Child’s Name: ____________________________
Youning Ji
OUTCOME 1 OUTCOME 2 OUTCOME 3
“Children have a strong sense of identity” “Children are connected with and contribute “Children have a strong sense of
to their world” wellbeing”
How can we assist your child to build What questions is your child asking about Jump can help my child socially and
confidence? the world around them? emotionally by:
My child needs assistance to develop the
following autonomy and self help skills:
OUTCOME 4 OUTCOME 5
“Children are confident and involved learners” “Children are effective communicators”
My child is currently interested in learning and is showing curiosity in I would like Jump to focus on the following areas of development
the following areas: with my child i.e. speech, fine motor, cognitive, emotional:
I would like my child’s learning outcomes at Jump to include: Are you concerned about speech development, literacy or any
area?