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Kindergarten Roundup 2023-24
Lanesville Kindergarten Roundup 2023-2024
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* Indicates required question
Kindergartener's (First and Middle) Name only
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Your answer
Kindergartener's (Last) Name
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Your answer
Does your child go by a nickname? If so, please share.
Your answer
Child's Birthdate (Month/Day/Year)
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Your answer
1. Parent/Guardian's Name and relationship to child
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Your answer
2. Parent/Guardian's Name and relationship to child
Your answer
Do you live in the Lanesville Community School District?
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Yes
No
Not sure
Please list your Home address
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Your answer
Your Name & cell phone number if we would need to contact you.
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Your answer
Cell Phone Carrier/Provider (examples: AT&T, Verizon, etc.)
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Your answer
Please provide an email address that you check frequently.
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Your answer
Did your child attend preschool?
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Yes
No
If yes, what pre-school(s) did your child attend and how many years?
Your answer
Does your child have siblings that attend Lanesville?
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Yes
No
Does your child have younger siblings at home?
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Yes
No
Did your child participate in a Head Start Program?
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Yes
No
Has your child received special services (speech, OT, etc. ? If yes, please list them.
Your answer
Handwriting: (Please mark one)
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My child is right-handed dominant.
My child is left-handed dominant.
My child uses both left and right hands.
I'm not sure.
Do you feel your child has trouble pronouncing certain words and could benefit from speech assistance?
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Yes
No
I'm not sure.
Mark all that apply: My child can...
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independently zips clothing (pants, jackets, etc.)
independently buttons (shirts, pants, coats, etc.)
tie their own shoes
can use scissors correctly
pick up after oneself
independently use the restroom
able to use utensils (at lunch)
able to open packages (snacks/ milk)
recognizes their name in print (on a cubbie or mailbox)
takes turns and shares with others
listens and follows simple directions
waits patiently
tries new things
colors neatly
attempts to solve problem independently
Enjoys listening to stories read to them
looks at picture books
can read books with words
listens to stories without being distracted
Required
Does your child have anxiety about anything? If yes, please list.
Your answer
What hobbies or activities does your child like to do?
Your answer
Does your child have any medical information that will need to be shared with our school nurse?
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Yes
No
Please check the following documents you brought today to share with the office: Check all that apply.
Birth Certificate
Shot records
Custody papers (if any)
Proof of residency (ex: bill with address)
Anything else you would like us to know about your child. Thank you for completing this form.
Your answer
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