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Kindergarten Entry Information 2021-2022
We appreciate you completing this developmental history form for your incoming student! Please understand that this wide-range of questions is just to give us an idea of your child's development and experiences, and NOT what we expect from incoming kindergartners! We look forward to meeting your kindergartners very soon! Mrs. Rowe & Ms. Martin (Kindergarten teachers), Mrs. Ferland (OT), and Mrs. Downer (Speech)
* Indicates required question
Email
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Your email
Person/People completing this form (and relationship):
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Your answer
What is your child's name (and nickname, if applicable)?
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Child's status in your family:
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oldest
youngest
middle
only
If your child has attended any pre-school program, what was the name of the program (if not, please respond n/a)?
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Your answer
Do you anticipate separation anxiety at the beginning of school?
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yes
no
not sure
Do you have concerns about your child's vision?
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yes
no
unsure
Do you have concerns about your child's hearing?
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Yes
No
unsure
Do you have concerns about your child's large motor skills (such as throwing a ball)?
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Yes
No
unsure
Do you have concerns about your child's small motor skills (such as drawing or cutting)?
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Yes
No
unsure
Do you have concerns about your child's speech or language skills?
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Yes
No
unsure
Has your child had any injuries or illnesses that may have affected any area of development (if not, please respond n/a)?
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Your answer
With whom does your child live?
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natural parents or parent
parent and stepparent
other
Do you feel your child's early motor skills (crawling, walking) developed:
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"delayed" (slower than siblings or others their age)?
"on target"
"advanced"
unsure
Do you feel your child's early speech/language skills developed:
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"delayed" (slower than siblings or others their age)?
"on target"
"advanced"
unsure
Is your child...
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right-handed
left-handed
unsure, or still uses both
Does your child still nap regularly?
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Yes
No
Would your child rather play:
alone
with younger children
with children their own age
with older children or adults
age doesn't matter
Option 6
Clear selection
Is or does your child... (please "check" all applicable choices)
get along well with siblings and/or other children
have difficulty concentrating
excitable/impulsive
have temper tantrums
clumsy/awkward
fully toiled trained
have difficulty expressing ideas
have sleep problems
destructive
suck their thumb
eat too little
always up and on the go
shy or withdrawn
fight and quarrel
worry a lot
put non food items in their mouth
make friends easily
Option 18
When playing with other children, is/does your child...(please "check" all applicable choices)
usually share without fussing
take turns
act as a leader
follow/understand rules of an easy game
have a sense of danger
stick for him/herself
push other children
afraid of being hurt (overly cautious)
get easily frustrated
Does your child follow a regular routine for mealtimes and bedtimes?
Yes
No
just mealtimes
just bedtimes
Clear selection
Does anyone read to your child? (you can check more than 1)
nearly every day
once in a while
no
my child is already reading books independently
Option 5
Clear selection
When someone reads to your child, do they:
pay close attention to the whole story
lose interest and doesn't pay attention
Clear selection
How many hours a day does your child watch tv (or other screen time)?
Your answer
Can your child do the following without help? (please check boxes to indicate a "yes" response)
zip a zipper
blow their nose
take care of all toilet needs
say where he/she lives
say first AND last name when asked
speak clearly enough to be understood
print their first name
tell right from left
use scissors
draw with crayons
use paints
button a shirt
tie shoelaces
say how old they are
say their birthday is when asked
say what parents do for a living
draw a person with body/arms/legs/face
draw a circle, square, triangle
count out 13 items when asked
name most colors (red, blue, green, yellow, orange, purple, brown, black)
Please use this space to further explain any of your responses, or to let us know anything we might not have asked, but you want to make sure we know!
Your answer
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This form was created inside of School Administrative Unit 53.
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