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CRS - Incoming Kindergarten Screener 2021-2022
Please fill this form out with as much detail as possible. These questionnaires will be reviewed by school staff and may be forwarded to Learning Inclusion if further assessment for supports and/or services is being queried.
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Email
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Your email
What is your child's name?
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Your answer
What is your name?
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Your answer
What is your phone number?
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Your answer
What are your child's interests?
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Your answer
What are your child's strengths?
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Your answer
Does your child communicate their wants and needs using full sentences primarily?
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Yes
No
Does your child communicate their wants and needs using 2-3 word phrases primarily?
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Yes
No
Does your child communicate their wants and needs using single words primarily?
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Yes
No
Does your child communicate their wants and needs using crying, gestures or signs?
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Yes
No
Would an unfamiliar listener understand 80+% of what your child is saying to them?
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Yes
No
Is your child able to follow simple 2-3 step directions (routines, rules)
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Yes
No
Has your child been involved in group settings such as daycare/dayhome, preschool, sports activities, etc.? Please describe.
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Your answer
Does your child seek to engage in play or communication with other children?
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Your answer
How does your child do with sharing and turn taking?
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Your answer
How does your child handle transitions within their day (ex. stopping play to eat, etc.)
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Your answer
Are there any strategies that you use to support your child with transitions or routine following?
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Your answer
If your child is expecting to do something and plans change, what is their response?
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Your answer
Describe your child's response to being separated from you (ex. going to daycare, etc.)
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Your answer
Describe how your child expresses emotions
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Your answer
Does your child persist with a challenging activity or do they refuse to continue without help?
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Your answer
Is your child able to feed themselves using utensils?
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Yes
No
Is your child able to toilet independently?
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Yes
No
Is your child able to dress themselves, including jacket and shoes independently?
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Your answer
Does your child show interest in fine motor activities such as colouring and cutting?
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Your answer
Does your child hold and use a crayon or pencil and scissors with a mature grasp?
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Your answer
Is your child able to navigate playground equipment independently?
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Your answer
Has your child had, or are they currently receiving, services or assessments from an SLP, OT, PT, specialized clinic (Glenrose, Stollery, etc.) Please describe.
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Your answer
Does your child have medical and/or physical conditions that would interfere with him/her participating fully in the classroom or that would require support to manage?
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Your answer
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