Getting to Know Your Child

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Getting to Know Your Child - Family Survey

Please help your child's teachers get to know your child by completing this survey.

Email *

Student's FIRST Name *

If your child prefers to be called by a nickname, what is it? (e.g., "Nick" instead of Nicholas)

Student's Birthday *

YYYY

Language(s) spoken at home with STUDENT? *

English

Spanish

Other:

Required

Name of Parent/Guardian 1 *

Parent/Guardian 1 - preferred contact phone number *

Parent/Guardian 1 - preferred email address
*

Parent/Guardian 1 - preferred language for class communications *

English

Spanish

Other:

Required

Name of Parent/Guardian 2

Parent/Guardian 2 - preferred contact phone number

Parent/Guardian 2 - preferred email address

Parent/Guardian 2 - preferred language for class communications

English

Spanish

Other:

Does your child have internet access at home on a regular basis? *

Yes

Other:

Required

How will your child be getting home from school?
*

Parent/Guardian Pick Up

School Bus

Walker

Other:

Required

If your child is a bus rider, what is their assigned MORNING bus number?

If your child is a bus rider, what is their assigned AFTERNOON bus number?

Same as morning bus.

Other:

Does your child have any known allergies? *

Yes

IF YES TO ALLERGIES, please list what your child is allergic to? Describe your child's allergic response.

IF YES TO ALLERGIES, does your child require the use of an Epipen? (If so, please remember to provide one to the school nurse.)

Yes

Other:

Clear selection

Does your child have asthma? *

Yes

Other:

IF YES TO ASTHMA, does your child require the use of an inhaler?

My child has an inhaler in their backpack.

The nurse has an inhaler for my child. (Please remember to provide the school nurse with an inhaler for your child.)

Clear selection

Does your child wear glasses? *

Yes, my child needs to wear prescription eyeglasses at all times during the school day.

Yes, for distance only.

Yes, for near point work only. (e.g., reading and writing)

Other:

Does your child take any medications that may affect their performance in school? *

Yes

Other:

IF YES TO MEDICATION, please describe performance effects that may be observed during the school day. (e.g., sleepiness, anxiety, jittery, hunger, etc.)

Does your child have specific sensory concerns that may affect their performance or well-being at school? *

Yes

None known at this time.

IF YES TO SENSORY, please briefly describe your child's sensory concerns and how she/he responds when encountering them.

IF YES TO SENSORY, what strategies and supports are most effective to assist your child when she/he encounters sensory concerns?

Please briefly describe your child socially. (e.g., level of comfort/ease interacting with peers and adults)

What are your child's interests? (e.g., sports, building, drawing, reading, etc.) *

What do you see as your child’s greatest strengths or skills? Tell me about a time when you saw your child demonstrating these skills.

What are some of your child's greatest challenges. Tell how your child responds when encountering difficulty due to these challenges.

What motivates your child to do his/her best?

Next June, what do you hope your child says about his/her experience in school this year?

What was your experience like in this grade? How do you remember that year of school?

What are your fears or concerns about your child in this year of school?

Is there anything else you can tell me about your child that you think would help me support his/her learning?

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