Sayen Kindergarten Registration 2019-2020
Social-Emotional Development and Readiness - Ms. Peck, School Counselor
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Email *
Child's Name *
Birthdate *
MM
/
DD
/
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Who is completing this form? *
Required
Preschool Information *
Required
Where does your child attend preschool? *
How long has your child been enrolled in preschool/daycare? *
Does your child have bathroom accidents during the day? *
Does your child have bathroom accidents at night? *
Is your child independent in the bathroom *
Does your child have difficulty in rooms with many people or loud noises (ie: movie theater)? *
Is your child able to sit at the dinner table for 10-15 minutes without getting up from the table? *
Does your child have playdates with children other than family members? *
What organized activities, if any, does your child participate in outside of preschool? (ie Sports, dance, music programs, etc) *
Has your child ever received any of the services listed below? *
Required
Are there any court orders, restraining orders, or custody issues that we need to be made aware of? *
Who lives in the house with your child? (House #1) *
Who lives in the house with your child (House #2)
Self-Awareness *
Strong Skill
Developing
Not Yet
Interested in new experiences
Can recognize and identify emotions
Feels good about him/herself
Self-Management *
Strong Skill
Developing
Not Yet
Able to talk about feelings
Can calm him/herself down
Can follow simple directions the first time they are given
Separates easily from caregivers
Shows physical self-control (does not hurt others)
Social Awareness *
Strong Skill
Developing
Not Yet
Shares and takes turns with peers
Is aware of and cares about how others feel
Beginning to understand that not everyone thinks and acts like them or shares the same beliefs
Responsible Decision Making *
Strong Skill
Developing
Not Yet
Understands right from wrong
Thinks about consequences before making choices or decisions
Relationship Skills *
Strong Skill
Developing
Not Yet
Shows interest in being part of a group
Listens to others
Shares with other people
Cooperates with peers
Affectionate with friends and family
Asks for help when needed
Other Information
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