Family Questionnaire for Back to School

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Thank you for taking the time to complete these questions about your child and family. I believe in building strong relationships with my students and their families.

What is your child's first and last name? *

Does your child go by a nickname? *

When is your child's birthday? *

YYYY

What is your child's primary address? *

Please list each caregiver's name and the phone number to best contact each person.

Please list each caregiver's name and the best email address to send important classroom information. *

Please list all family members who live in the child's primary household, their relationship to the child, and ages (if siblings). I don't need parent ages :) *

Does the student have a secondary home that he/she splits time with? If so, please list the family members. Please share the days of the week your child stays at this home. *

Are there any other languages spoken at home? Please share which language. *

How does your child get home each day? *

bus rider

car rider

walker

virtual learning

Other:

What are 3 things your child enjoys doing outside of school? *

List 3 or more strengths of your child. *

Does your child struggle with anything in school? If so, please explain. *

How does your child feel about school? *

Does your child make friends easily? *

Yes

Other:

Please List 2-3 goals you have for your child this year. *

How does your child learn best? What motivates your child? *

Does your child have any food allergies or medical conditions? *

What other information should I know about your child? *

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