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Kindergarten Orientation Parent Survey
2022-2023 School Year
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* Indicates required question
First and Last name of Kindergarten Student
*
Your answer
Child's Date of Birth:
MM
/
DD
/
YYYY
Parent / Guardian Name(s), Address, and Email
*
Your answer
Did your child attend preschool?
Yes
No
Other:
Clear selection
Does your child have an Individual Education Plan (IEP)?
Yes
No
Clear selection
Does your child have a 504 plan?
Yes
No
Clear selection
What languages are spoken in the home?
English
Spanish
Arabic
Chinese (Mandarin/Cantonese)
French
Other:
Clear selection
My child is very good at
Your answer
One of the things I want my child to learn this year is
Your answer
Something you should know about my child is
Your answer
When my child is around other children they
Your answer
It is easy for my child to separate from me.
Yes
No
Sometimes
Clear selection
If no or sometimes, please list things that help your child transition.
Your answer
There is a health concern with my child that I need to talk to the nurse about.
*
Yes
No
Maybe (please have the nurse follow up)
Is there anything else you would like to share about your family that will help us build a positive relationship?
Your answer
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