Potty Training Course Questionnaire Tell us more about you and your situationName First Last Which child(ren) do you have toileting concerns about? Describe the concerns briefly.*What is your first name and the first names of your child(ren) and their age(s):*Briefly describe steps you have taken toward toilet training (for example: bought a potty, spent two days on intensive training, provide reminders to use potty, praise potty use, nighttime reminders):*Is your child still using diapers some/all of the time? When?*Please list any books or websites about toilet you consulted:Do you have someone else in your household helping with toilet learning? What is their role?During our sessions, we would like to include some of your story with others. Please note here anything want to share privately with coach JoAnn Robinson, but do not want to share with others:AvailabilityBest times for you to attend the class* Select All Mornings 8:30-9:30 am Mornings 9-10 am Afternoons 12-1 pm Afternoons 12:30-1:30 pm Evenings 5:30-6:30 pm Evenings 7:30-8:30 Evenings 8:15-9:15 OtherPlease select all that applyIf you selected "other", please share your ideal times for participating in your classPrivacy* By using this form you agree with the storage and handling of your data by this website.
