2024-25 Complete Student Information Form
Please answer all of the following questions completely and accurately. The information provided will be used solely by Good Shepherd Lutheran Preschool and will remain confidential.
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Email *
Child's First Name *
Please enter your child's full first name as it appears on their birth certificate (i.e., no nicknames).
Child's Middle Name
Please enter your child's full middle name as it appears on their birth certificate. Leave blank only if your child does not have a middle name.
Child's Last Name *
Please enter your child's full last name as it appears on their birth certificate.
Child's 2024-25 Class *
Basic Information
Child's Preferred Name *
Please list your child's preferred name, nickname, or what he/she is usually called at home.
Child's Place of Birth *
City, state, country
Citizenship *
Is the child a U.S. citizen?
Neighborhood Elementary School
Please list the public school where your child would attend kindergarten based on where you live now. If you are unsure, enter your address here: http://bit.ly/gslp-mcps
Family and Household Information
Adult 1 Name *
Adult 1 Relationship *
Adult 1 Occupation
Adult 2 Name
Adult 2 Relationship
Clear selection
Adult 2 Occupation
Parents' Marital Status *
What is the marital status for the child's parents? (Please note that if there is a custody agreement for the child, a copy must be on file in the Preschool Office.)
Parents' Residence *
Do both parents reside in the same household?
Describe Living Arrangements
If children do not live in the same household as both parents, please describe the living arrangements and custody details below.
Other Household Members
Please list the names and ages (if under 21 years old) of others living in the household and their relationship to the GSLP student.
Religious Belief *
Does your family profess a specific religious belief?
What is the child's primary language? *
Please list any other languages spoken at home.  *
If a language other than English is the child's primary language, please describe the child's familiarity with or exposure to English. *
Religion
If you checked "Yes" above, please list your family's religion(s).
Values and Traditions
GSLP values a diverse student body. Are there any cultural or religious values, beliefs, traditions, celebrations, or customs that are especially important to your family?
Child-Rearing Practices
Please describe any culturally based child-rearing practices that may help staff members meet your child's needs.
Child's Habits and Routines
Bedtime *
When does your child usually go to bed?
Time
:
Wake-Up Time *
When does your child usually get up in the morning?
Time
:
Naps *
Does your child nap during the day?
Nap Length
If your child naps, when does he/she nap and for how long?
Toileting Habits *
Please check all that apply.
Required
Toileting Hints
Does your child have any special words, expressions, or actions concerning toileting habits that the teacher should know?
Child's Experiences and Reactions
Easing Separation
Please describe any strategies you use to help ease the transition if your child has difficulty separating from you or the primary caregiver.
Describe Other Programs
Has your child participated in an early childhood program, daycare, playgroup, or class (sports, art, dance, music, language, Sunday School, faith formation, etc.) other than GSLP? If yes, please describe any other programs your child has participated in.
Reaction to Other Children *
How does your child respond in situations where other children are present?
Fears *
What fears does your child have? How are they expressed?
Frustration *
How does your child react when frustrated by a situation?
Technology Access
My child has access to (check all that apply):
Child's Interests and Needs
Physical Activities *
My child enjoys the following physical activities:
Toys and Games *
My child especially enjoys playing with these toys:
Characters *
Some of my child’s favorite fictional characters (such as Thomas the Tank Engine, Minnie Mouse, Elmo, etc.) are:
Other Likes *
My child likes the following things:
Dislikes *
My child dislikes the following things:
Skills *
Some things my child does well are:
Skills in Progress *
I am working with my child on:
Individual Needs *
My child might need help with:
Hopes and Expectations *
Why did you enroll your child in preschool? What hopes and expectations do you have for your child as a result of his/her participation in the GSLP program?
Medical Information
Allergies *
Does your child have an allergies (especially to food and medicine)? If yes, please list below.
List Allergies
If you checked "Yes" above, please briefly list your child's allergies.
Chronic Medical Conditions *
Does your child have any chronic medical conditions (such as diabetes, asthma, sickle cell anemia, etc.)? If yes, please list below.
List Chronic Medical Conditions
If you checked "Yes" above, please briefly list your child's chronic medical conditions.
Medications *
Is your child on any routine medications? If yes, please list below.
List Medications
If you checked "Yes" above, please briefly list your child's routine medications.
Premature Birth *
Was your child born prematurely?
Weeks Premature
If you checked "Yes" above, please select the option that best describes your child.
Hospitalizations *
Has your child had surgery or been hospitalized for more than 24 hours? If yes, please describe below.
Describe Hospitalizations
If you checked "Yes" above, please briefly describe your child's hospitalizations.
Vision or Hearing Issues *
Have you noticed any vision or hearing problems? If yes, please describe below.
Describe Vision or Hearing Issues
If you checked "Yes" above, please briefly describe your child's vision or hearing problems.
Other Medical Issues *
Are there other medical circumstances the Preschool should know about your child? If yes, please describe below.
Describe Other Medical Issues
If you checked "Yes" above, please briefly describe your child's other medical circumstances.
Screenings and Services
IEP or IFSP *
Does your child have an Individualized Education Program (IEP) or an Individualized Family Service Plan (IFSP)?
IEP or IFSP Accommodations
Please summarize any accommodations necessary for your child while in school listed in your IEP or IFSP.
Share IEP or IFSP
If your child has an IEP or IFSP, are you willing to share a copy of it with GSLP so that your child's teachers may use it to plan accommodations in the classroom?
Clear selection
Developmental Screenings *
Has Child Find, Infants and Toddlers, or an other screening agency (speech, occupational therapy, etc.) evaluated your child? If yes, please describe below.
Describe Screenings
If you checked "Yes" above, please describe any screenings your child has had.
Disabilities *
Does your child have any diagnosed learning or other disabilities? If yes, please describe below.
Describe Disabilities
If you checked "Yes" above, please describe any disabilities your child has had diagnosed.
Services Received
Please indicate which, if any, of the following services your child has received:
Describe Services
If you checked any services above, please describe, in detail, the services received (age begun, frequency, diagnosis, etc.).
Other Developmental Concerns *
Do you have concerns about your child's development (behavior, language, speech, coordination, etc.)? If yes, please describe below.
Describe Other Developmental Concerns
If you checked "Yes" above, please describe any other concerns you have about your child's development.
Racial and Ethnic Identification
Hispanic Ethnicity
Is your child of Hispanic, Latino, or Spanish origin?
Clear selection
Racial Identification
Please indicate your child’s racial identification by marking one or more of the following categories from the US Census:
Dietary Information
Dietary Restrictions
Please check below if your child should adhere to any of the following dietary restrictions:
Describe Dietary Restrictions
If you checked a dietary restriction above, please describe anything GSLP should know about your child's dietary restrictions so that we can help your child adhere to them.
Foods Your Child CANNOT Eat
ITEMS THAT YOU CHECK OFF BELOW WILL **NOT** BE SERVED TO YOUR CHILD AT SCHOOL.

Check off any food items your child **SHOULD NOT** be served at school due to an allergy, medical restriction, cultural restriction, or ethical restriction.

PLEASE NOTE: Do not check off items your child simply does not like to eat. We encourage but do not force children to try new foods at preschool as part of teaching children about health and nutrition.
Specific Food Restrictions
Check the box next to any foods your child is not permitted to consume at school.
Milk in Processed Food
If you checked "Milk" or "Milk Products" above: May your child have milk if it is part of a cooked or processed food, such as cake or crackers?
Clear selection
Eggs in Processed Food
If you checked "Eggs" above: May your child have eggs if they are part of a cooked or processed food, such as cake or crackers?
Clear selection
Other Foods to Avoid
Please list any other foods to avoid and state the reason they should be avoided. Be sure to list any food allergies or medical dietary restrictions on your child's Health Care Plan as well.
Student Directory Information
You may leave blank any information below that you do not wish to be published in the Student Directory. Including more information makes it easier to form connections with other preschool families for play dates and other activities.
Street Address
City
State
Zip Code
Preferred Email Address
Preferred Phone Number
Birthdate
MM
/
DD
/
YYYY
Gender
Clear selection
Parent/Guardian 1 Name
Parent/Guardian 1 Relationship
Clear selection
Parent/Guardian 2 Name
Parent/Guardian 2 Relationship
Clear selection
Student Directory Permission *
I grant permission for the information in this section above to be included as part of my child's class list in the GSLP Student Directory, printed and distributed only to current Preschool families.
Additional Comments
Please include any additional information you think might be important for us to have.
Electronic Signature *
Type your full name below to sign this form.
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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