Child development questionnaire 4 years old+

Your first and last name*

Child's name*

Child's birthday*

4-5 Years Questionnaire

Welcome to Happy Baton! We’re so excited to bring you a box of toys that are put together specific to your child’s needs. We just need to know more about your child to curate a toy box that will truly help him/her to thrive. Please fill out this questionnaire below and indicate whether your child displays the following behaviors with yes/sometimes/no.

Cognitive

1. Counts 10 or more things?

Yes
Sometimes / Shows intention of doing
Not yet

2. Can draw a person with at least 6 body parts?

Yes
Sometimes / Shows intention of doing
Not yet

3. Can recognise some letters or numbers?

Yes
Sometimes / Shows intention of doing
Not yet

4. Copies a triangle and other shapes?

Yes
Sometimes / Shows intention of doing
Not yet

5. Understands time concepts? (eg: last week, tomorrow morning)

Yes
Sometimes / Shows intention of doing
Not yet

Language

1. Speaks very clearly?

Yes
Sometimes / Shows intention of doing
Not yet

2. Tells a simple story using full sentences?

Yes
Sometimes / Shows intention of doing
Not yet

3. Uses future tense; for example, “Grandma will be here.”?

Yes
Sometimes / Shows intention of doing
Not yet

Physical

1. Stands on one foot for 10 seconds or longer?

Yes
Sometimes / Shows intention of doing
Not yet

2. Hops and skips?

Yes
Sometimes / Shows intention of doing
Not yet

3. Uses a fork and spoon and sometimes a table knife?

Yes
Sometimes / Shows intention of doing
Not yet

Social/Emotional

1. Wants to be like friends?

Yes
Sometimes / Shows intention of doing
Not yet

2. Can separate from parents easily?

Yes
Sometimes / Shows intention of doing
Not yet

3. Cooperates with 4-5 kids while playing?

Yes
Sometimes / Shows intention of doing
Not yet

4. Can express emotions using simple words? (may require prompting)

Yes
Sometimes / Shows intention of doing
Not yet

5. Shows embarrassment?

Yes
Sometimes / Shows intention of doing
Not yet