JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Kindergarten Questionnaire
Please fill out this form prior to your Kindergartener's screening date.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's Full Name
*
Your answer
Name to be used at school:
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Child's Gender
Boy
Girl
Clear selection
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Contact Phone Number
*
Your answer
Father's Name
Your answer
Father's Occupation
Your answer
Father's Employer
Your answer
Father's Work Phone Number
Your answer
Mother's Name
Your answer
Mother's Occupation
Your answer
Mother's Employer
Your answer
Mother's Work Phone Number
Your answer
Guardian's Name (if applicable)
Your answer
Relationship to student
Your answer
Guardian's Contact Phone Number
Your answer
Marital Status of Parents:
Married
Separated
Divorced
Single
Mother deceased
Father deceased
Clear selection
Child living with:
*
Both parents
Father
Mother
Father/Stepmother
Mother/Stepfather
Grandparents
Guardian
Are there adults, other than parents, living permanently in the home? If so, please list:
Your answer
Siblings (Brothers) List name(s) & age(s):
Your answer
Siblings (Sisters) List name(s) & age(s):
Your answer
Do any siblings attend Latimer School?
Yes
No
Clear selection
If yes, list name(s) and grade(s)
Your answer
Is your child registered to attend morning care and/or after care at Moreland Extended Day?
*
Morning Care
After Care
Both morning and after care
My child will not attend morning or after care at Moreland Extended Day
Language child speaks at home?
Your answer
Does your child understand English?
Yes
No
Clear selection
Has there been a divorce, death, or major illness in the family which might affect your child?
Yes
No
Clear selection
If you answered yes to the question above please explain:
Your answer
Does your child have hearing loss?
*
No
Yes
Does your child have vision loss?
*
No
Yes
Wears glasses
Does your child have any allergies?
*
Your answer
Has your child had any frightening experiences we should know about?
*
Your answer
What holidays does your family celebrate?
Your answer
What time does your child get up in the morning?
*
Time
:
AM
PM
What time does your child go to bed at night?
*
Time
:
AM
PM
Does your child nap? (If yes, what time?)
*
Your answer
How does your child feel about starting school?
*
Your answer
How will your child be getting to and from school?
*
Your answer
Which preschool did your child attend?
Your answer
Dates attended preschool?
Your answer
Preschool teacher's name & phone number?
Your answer
Do we have permission to contact this teacher?
Yes
No
Clear selection
Kindergarten is a grade-level where children come in with a wide range of abilities. Please pick one category that best indicates the skill set on which your child is currently working:
*
working on identifying letters in their name
working on recognizing letters and sounds
beginning to read words (for example: and, the, like, cat, map, pin)
is reading (for example: could read The Cat and the Hat)
is reading (for example: could read The Cat and the Hat and write a thank you note to a friend independently)
Is there anything else you would like to tell us about your child, such as special needs, special skills, experiences, or health concerns?
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Moreland School District.
Report Abuse
Forms
