Kindergarten Questionnaire
Kindergarten Questionnaire
Student's Name: _________________________________
Birth date: _______________________________________
Address: _____________________________________________
Home Phone # _________________________________________
Emergency Phone # _____________________________________
Mother's Name: _________________________________
Occupation: ____________________Working Hours: _______________
Father's Name: _________________________________
Occupation: ____________________Working Hours: ______________
Business Phone # (mother) ____________ (father) ___________________
Your child's household includes:
Mother ____Father ____Grandmother ____Grandfather ____ Aunt ____Uncle ____
Siblings: (names and ages) ___________________________________________
Others: _______________________________________
Child's Nickname if he/she has one: ___________________
Did your child attend pre-school?
3yr.: Yes_____ No _____ Name of school ___________
4yr.: Yes____ No _____ Name of school ____________
My child is.... Left-handed ____ Right-handed ____ Not Sure ____
What is your child's bedtime? ________
Does your child usually take a nap? Yes ____ No ____ over >
Does your child have any allergies? Yes ____ No ____ If yes, please list: ___________________________________________________________________________________________________________________________________________
Does your child have any physical disabilities? If yes, please list and include any medications that he/she is taking:
___________________________________________________________________________________________________________________________________________
Does your child have any learning difficulties and or behavioral problems that you are aware of? If yes, please list and include any medications that he/she may be taking:
_____________________________________________________________________________________________________________________________________________
Parent's Signature: ________________________________
Sincerely,
The Kindergarten Teachers
* Please use the bottom of this form to describe your child's personality (ex. outgoing, shy, nervous) and include anything else that you would like me to know to help your child have a wonderful year.
**** Please return this form on your child's first day of school.