St. Michael Prekindergarten Student Information Form
Please answer the following questions for your Prekindergarten Student.
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Email *
Any comments or additional notes (i.e. unique family situation, only wanting one parent email shared, etc.) *
Student Name *
Student Nickname *
Parent Names
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If your child has a nickname, please write which name you would like us to teach them for spelling and handwriting practice. *
Date *
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Authorized Pick Up  
For your child’s protection, please fill out the name of authorized persons to bring, or take your child from the preschool, other than yourself. Please inform the authorized persons to be prepared to identify themselves to our staff with an ID. Please list a parent other than one signing this, if authorized to pick up.  Please make sure the person picking up your child has a car seat in their car.
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Authorized Pick Up  
Is there anyone who might stop for your child that you do NOT wish to have your child released to (other than parent)?
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Authorized Pick Up  
In case of a car pool arrangement, tell us below what the arrangement will be:
St. Michael’s Prekindergarten Parent Handbook Review Form 
I have received a copy of the St. Michael Preschool Prekindergarten Parent Handbook and have reviewed the policies related to my child’s enrollment in the St. Michael Prekindergarten Program. Typing name below indicates signature of Parent or Guardian   
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  St. Michael’s Prekindergarten Tuition 
 I hereby agree to pay the tuition and fees for my children enrolled in St. Michael Preschool in accordance with the payment plan chosen on FACTS.  I understand that a late fee will be assessed if any tuition payment is not received within seven days of the due date. In addition, a $40.00 fee will be assessed each time a check is returned for insufficient funds. Typing your name below indicates you have read the following and that you (1) agree to pay the tuition and fees for your children enrolled at St. Michael Prekindergarten. This payment plan will remain in effect for the school year unless the principal or pastor approves a change in plan. Typing name below signifies signature. 
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Consent For Release of Personally Identifiable Information The undersigned parent or guardian of the student named below, a student at St. Michael Prekindergarten, Worthington, Ohio, hereby consents to the release of the following information:

Specific information to be released: Photographs and press releases describing St. Michael School activities or achievements, including names for certain achievements 

Reason for release: General public relations purposes such as promoting the involvement of St. Michael School and its students in educational, religious and community activities

Information to be released via: 
Press releases with photographs issued to generally available media such as community newspapers, regional newspapers, local radio news, local television news, the Catholic Times, St. Gabriel Radio, and other local media. Photographs and descriptions of activities and achievements may also be used on the School’s webpage 

The undersigned consents to the transfer of the above information to a third or subsequent party. 
Print Parent / Guardian Name
Print Student Name 

Signed NOTE: This is a general consent requested near the beginning of the school year. If you want to refuse permission, please print the student’s name, print REFUSED on the signature line.
Typing name below signifies signature.
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PreK Permission to share contact information
We are in the process of creating a Prek directory for the 2024-2025 SY.  please take a moment to indicate weather you wish your contact information to be shared and, if so, where it may be shared.  Thank you!  
Please check what you approve to be shared in a directory:
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Required
PreK Permission to share contact information
Please select where you would like your information shared:
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Required
PreK Permission to share contact information  Any comments or additional notes (i.e. unique family situation, only wanting one parent email shared, etc.)
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St. Michael Prekindergarten Technology permission 
St. Michael Prekindergarten would like to use the Kindle Fire tablets for Phonics, Math, Social Studies and Science practice. A child who uses the tablet will have approximately 5 (or 10 minutes at the maximum) screen time to practice academic skills. We will not use them every day and the children will not have internet access since programs are on the tablet. The use of Kindle Fire tablets will be during academic or free play center time. Please  talk to your child about being respectful and careful with the tablets. Below are some of the many features on the tablet we plan to use: Tactile screen on tablet front to practice writing letters Math and phonics games Social Students and Science games Story read aloud Video the students acting out a story and watch the video they made as a class.

St. Michael Prekindergarten Acceptable Use Policy: 
Student: St. Michael Prekindergarten staff will monitor student use of tablets St. Michael Prekindergarten students will: *be careful with the tablet *ask for help *only use the games my teacher gives me on the tablet *listen to my teacher when my turn is finished.

Parent: As the parent or legal guardian of the student listed below, I have read this Technology Acceptable Use Policy and grant permission for my child to use the Kindle Fire tablet for educational purposes. 
Typing name below signifies signature. 
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  http://wow.boomlearning.com 
Boom Learning
OPT-IN PERMISSION SLIP 
Boom Learning enables teachers to assign your student self-grading digital resources. Students who use Boom Learning receive immediate feedback and learn as they play.  
You may contact your teacher at any time to revoke permission. Revoking permission will result in all your student’s performance data being deleted and is not reversible. 
When your student engages with a resource, Boom Learning provides your teacher with immediate feedback about how your student performed, including answers selected (correct and incorrect) and time spent on each task. 

To allow your student to use Boom Learning in the classroom, please complete this form.  The purpose of allowing your student to opt-in is to benefit your student’s education. You are agreeing to the Boom Learning Privacy Policy (https://wow.boomlearning.com/privacy) by opting-in. The St. Michael Preschool Director has control over this closed site.  
 Typing name below signifies signature. 
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Parental Permission Form for Class Pets Child’s 
The specific animals to live in classrooms:  Flopsy the bunny, Whiskers the dwarf hamster  Nibby the hamster, both classrooms- butterflies, tadpoles and chicks in the spring. The specific animals to visit for one day during the school year in the classrooms: Hedgie the Hedgehog

The pet for your child’s classroom may aid in achieving the following learning objectives: 
SCI 1 With modeling and support, identify physical characteristics and simple behaviors of living things. 
SCI 2 With modeling and support, identify and explore the relationship between living things and their environments. 

● Should you have any concerns regarding this animal (exg. Allergies, other medical sensitivities, sanitation practices, etc.) 

Please contact Mrs. Wells at lwells@cdeducation.org. 

Typing name in the "other" section signifies signature. 
  FOR STEP UP TO QUALITY PROGRAMS (SUTQ)
  
By providing complete information about your child, you will be assisting staff in creating a positive experience for him/her while in care. List any information about your child's habits, abilities or personality that you feel will be helpful to the staff while caring for your child. 
Who lives at home with your child?
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Who is in the child's immediate family? 
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What is the primary language spoken in your child’s home? 
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What is the primary faith that your family practices? *
Are there any special family arrangements, such as shared parenting, living in two homes, or custody specifications, etc.? 

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Do you have custody paperwork for your child? *
Are there any changes or transitions that your child has recently experienced or is experiencing? (moved from crib to bed, divorce, new home, death of family member, friend or pet) 
Additional Details? 
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Do you have any pets at home? If so, what are they and what are their names? 

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Has your child had a previous care arrangement? Yes or No Additional Details? (Center based, in home, with family, with parents, etc.)
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Are there any cultural or religious practices of your family we should be aware of? (Dietary restrictions, clothing, head coverings, etc.)
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Where is your child Baptized? *
My child drinks milk, formula, juice or water. (Check all that apply) How much and how often? 
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Required
Does your child have any favorite foods?

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Does your child dislike any foods?
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Are there any foods your child should not be fed? (Licensing requires documentation be completed for children with food allergies and/or dietary restrictions)
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 Please check all of the words that best describe your child’s personality and behavior:
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Required
Are there additional personality and behavior characteristics that would be useful to know about your child?
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Is your child on an IEP or an equivalent plan? *
What other information would be helpful for the staff caring for your child to know?    
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Are there things that frighten your child? If so, how does he/she react and what do you do to comfort him/her?
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 What routines/actions or items do you use to comfort your child? 
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What causes your child to feel angry or frustrated? 
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What methods do you use to respond to your child’s negative behavior? 
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Does your child use any special comfort or support items that help him/her go to sleep? If so, what? 
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What is your child’s mood upon waking? (happy, grouchy, clingy, slow to awaken)? 
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My child sits in a high chair, booster, child size chair or adult size chair. (Check the one that applies.)
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For our program your child needs to be child toilet trained. Your child should not need assistance when using the toilet. What words, gestures or signs does your child use if he/she needs to use the bathroom? 
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What time does your child normally go to bed at night and wake up in the morning? 
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What time(s), and for how long, does your child usually nap?
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 Does your child have trouble sleeping (Night terrors, trouble going to sleep, etc.)? Please explain. 
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What might you and/or your child be anxious about as he/she starts in this program?  *
What are you and/or your child excited about as he/she starts in this program?
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 What are your expectations of this program? 
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