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Child Information & Enrollment Profile Survey

Collects the background, health, and behavioral information childcare centers, schools, and youth programs need to support a child well — routines, needs, and preferences alongside an AI follow-up that draws out the specific things a new caregiver should know on day one. Built for intake and enrollment teams.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全15問・約8分
Q01
メッセージ

<p>Welcome! To help us care for your child well from day one, we'd like to learn a bit about them — routines, needs, and personality. This takes about 6 minutes and your answers go straight to your child's care team.</p>

Q02
自由回答（短文）必須

What is your child's first name (and nickname, if they go by one)?

Q03
日付必須

What is your child's date of birth?

Q04
選択式必須

Does your child have any allergies, medical conditions, or medications our staff should know about?

  • No known allergies or conditions
  • Food allergies
  • Other allergies (e.g., environmental, medication)
  • Ongoing medical condition
  • Takes regular medication
Q05
自由回答（長文）

Please describe any allergies, conditions, or medications in detail, including what we should do in an emergency (e.g., EpiPen location, dosage instructions).

Q06
マトリクス必須

How would you describe your child in each of these areas?

5行 × 5列
  • Separating from parents/caregivers
  • Following instructions from a new adult
  • Playing with unfamiliar children
  • Trying new foods or activities
  • Managing frustration or disappointment
列: Struggles a lot · Struggles a little · Neutral · Does well · Does very well
Q07
選択式

Which best describes your child's daytime nap or rest needs?

  • Needs a scheduled nap
  • Rests only if tired
  • No longer naps
  • Not applicable / unsure
Q08
自由回答（長文）

Describe your child's typical daily routine (meals, naps, comfort items) so we can keep things consistent for them.

Q09
オピニオンスケール必須

How confident are you that our team currently understands your child's individual needs?

スケール: 1 – 7
最小:Not confident at all最大:Extremely confident
Q10
AIインタビュー

Explore the one or two things this parent is most anxious about for their child in a new care setting — anchor on whatever they rated lowest in confidence or flagged in the routine/behavior questions. Ask for a specific recent example of what helped (or didn't) when someone unfamiliar cared for their child, and what a caregiver should do differently in the first week. If they say everything is fine, ask what would make them feel even more confident.

Q11
自由回答（短文）必須

Who should we contact first in an emergency, and what is the best phone number to reach them?

Q12
選択式

Is there anyone who is NOT authorized to pick up your child?

  • No restrictions
  • Yes — details below
Q13
自由回答（長文）

If there are pickup restrictions or custody arrangements we should know about, please describe them here.

Q14
選択式

What is your child's gender?

  • Boy
  • Girl
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q15
メッセージ

Thank you for sharing this — it goes directly into your child's care profile so our team can support them from the very first day. You can update these details any time by contacting us.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Goes beyond checkbox allergy fields with a dedicated long-text prompt asking for the specific allergy, condition, or medication details and what staff should do about them
  • Includes an AI follow-up interview that draws out the one or two things a parent is most anxious about for their child, so caregivers get context no static form captures
  • Combines structured intake (DOB, nap needs, emergency contact, pickup authorization) with a behavioral matrix and an opinion-scale check on how confident staff feel about knowing the child already
  • Frames the whole survey around day-one caregiving needs, closing with a message confirming the data feeds directly into the child's care profile

Jotform

Child Information Form Template

A ready-to-use, drag-and-drop form template for collecting basic child and guardian information. It's built for quick deployment and customization within Jotform's form builder ecosystem, but it functions as a static data-collection form rather than an interview. Best suited to centers that just need to capture fixed fields, not probe deeper on a parent's specific concerns.

優れている点

  • Easy to customize via drag-and-drop form builder
  • Fielding-ready template that integrates with Jotform's broader form/workflow ecosystem
  • Likely supports common field types (text, date, multiple choice) out of the box

物足りない点

  • No adaptive AI follow-up — every parent sees the same static questions regardless of their answers
  • No voice AI interview option or guided screen-share tasks
  • No automated per-response quality scoring or auto-generated reports

SurveySparrow

Child Information Form Template | For Educational & Healthcare Providers

A conversational-style child information template pitched specifically at educational and healthcare providers, which makes it a close comparison for intake teams. It emphasizes a friendlier chat-like UI for form-filling, but it remains a fixed-question template rather than a true adaptive interview. There's no indication it can dynamically probe deeper based on a parent's specific responses.

優れている点

  • Conversational UI designed to feel less clinical for parents filling it out
  • Positioned directly at educational and healthcare provider intake use cases
  • Likely offers standard customization and branching logic common to SurveySparrow forms

物足りない点

  • No adaptive AI-driven follow-up questions that dig into individual parent concerns
  • No voice AI interview mode or guided screen-share task support
  • No transparent, publishable prompt methodology or automated quality scoring of responses

よくあるご質問

「Child Information & Enrollment Profile Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が15問含まれており、最初の設問は次のとおりです：「<p>Welcome! To help us care for your child well from day one, we'd like to learn a bit about them — routines, needs, and…」・「What is your child's first name (and nickname, if they go by one)?」・「What is your child's date of birth?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、15問を約8分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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