Name________________________ Date of Birth_____________ SSN______________
Answer the following yes or no:
Part 1: INFANT BODILY FUNCTIONS:
| 1. |
(Y/N) |
I can shake open a diaper and hold down a squirming toddler at the same time. |
| 2. |
(Y/N) |
I can place a towel, diaper, or other absorbent material over squirming male toddler within .05 seconds of him starting to firehose. |
| 3. |
(Y/N) |
I can recognize the smell of a misplaced diaper from 25 yards, within 2 minutes of it having been spread all over the crib. |
| 4. |
(Y/N) |
I can effectively explain to the older child (if any) that no, it's not good to say that, even though yes, technically, that's what the baby did. |
| 5. |
(Y/N) |
My clothing is purchased covered with patterns, spots or flowers to hide spitup, slobber, vomit, tears, blood, or__________ (other, see #4.). |
Part 2: EATING AND DRINKING:
| 6. |
(Y/N) |
I can dive for the bowl of milk and cereal being hurled from the high chair from (choose one): ____2 feet away ____5 feet away ____10 feet away ____15 feet away* |
| 7. |
(Y/N) |
I can get gum out of anything. |
| 8. |
(Y/N) |
I can get crayon out of anything. |
| 9. |
(Y/N) |
I can get crayon out of gum. |
| 9a. |
(Y/N) |
When both are in the child's mouth. |
| 10. |
(Y/N) |
I believe peanut butter is a complete meal. |
| 11. |
(Y/N) |
I understand that children subsist on air, carpet lint, stray tortilla chips and cereal from under the high chair. I am aware I cannot change this pattern. |
| *6. The longer the distance, the greater the entertainment value for the toddler. |
Part 3: CLOTHING, BATHING AND HYGIENE:
| 12. |
(Y/N) |
I am aware that peanut butter is not considered "dirt." Further, I am aware that any attempt to remove said peanut butter could result in permanent bite marks, ruptured eardrums, or kick dents in the furniture. |
| 13. |
(Y/N) |
I am aware that I will require unlimited laundry resources, and I will endeavor to further the child's learning-by-doing by constantly laundering everything the child soils as soon as the child soils it.** |
| 14. |
(Y/N) |
I can matter-of-factly drop whatever I am doing at any given time and accompany a toddler to the potty. |
| 14a. |
(Y/N) |
In public. |
| 14b. |
(Y/N) |
Loudly. |
| 15. |
(Y/N) |
Amendment to #11: I am aware that older infants and young toddlers add bath toys to their subsistence for fiber, as well as bath water for variety. |
| **13. |
Panels reviewing applications are aware that this question is moot:
98.5% surveyed answered (N).
Another 1.2% dishonestly answered (Y).
The remaining 0.3% who honestly answered (Y) were, unfortunately, too anal to have children. |
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