JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
EHES Kindergarten Parent/Guardian Interview Form
Hello incoming Kindergarten families! We are so excited to learn more about your child. Please take the time to fill out this comprehensive questionnaire. This will support the EHES team with the Kindergarten screening process for the 2024-2025 school year. We look forward to meeting you and your child and welcome you both into the East Haddam Elementary School family.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
What is your child's name?
*
Your answer
What is your child's date of birth?
*
MM
/
DD
/
YYYY
Name of Parent/Guardian #1 completing this survey.
*
Your answer
Name of Parent/Guardian #2 completing this survey.
Your answer
Please list incoming kindergarten student's siblings and dates of birth.
Your answer
Did you child attend preschool/nursery school?
*
Yes
No
Information in this section is ONLY if your child attended Preschool or Nursery School
Name of Preschool/Nursery School
Your answer
How many days per week did they attend?
1
2
3
4
5
Clear selection
My child attended
Full time
Part time
Clear selection
I give the staff at East Haddam Elementary School permission to contact my child's preschool/nursery school.
Yes
No
Clear selection
Contact person's first and last name.
Your answer
This section is to get to know a little about your child from your perspective. This is a very important part of this process, so please fill out as entirely as possible.
How does your child feel about starting Kindergarten?
*
Your answer
How does your child separate from immediate family members in new situations?
*
With ease, no difficulty at all.
Varies on the person and situation.
My child has a hard time separating from us and gets upset.
What are your child's interests? (include favorite toys, books, participation in other activities, etc.)
*
Your answer
Who does your child like to play with?
*
Your answer
How does your child learn best? (hearing information, talking/discussing, seeing things, singing/music, art activities, doing hand-on activities, etc.)
*
Your answer
Please share things that upset/worry/scare your child?
*
Your answer
Give a brief description of your child's personality (i.e. shy, outgoing, cautious, adventurous, inquisitive, fearful, etc.)
*
Your answer
My child is able to follow simple directions_____.
*
inconsistently.
with prompting.
consistently.
with more than one step.
My child sit for a short period of time______. (choose all that apply)
*
when eating
when listening to a story
when playing
not at this time
Required
At what stage is your child in toilet training?
Completely independent in the bathroom
Requires minimal assistance on occasion
Requires regular assistance in the bathroom (wiping, changing clothes)
Wears disposable underwear due to accidents
Clear selection
Which hand does your child use most of the time?
*
right
left
both hands equally
If your child uses scissors, can they cut on a line?
*
Yes
No
My child has not used scissors.
How many letters can your child identify in their first name? (please list the letters they can identify)
*
Your answer
How many numbers between 1 and 10 can your child identify? (please list numbers they recognize by sight)
*
Your answer
My child can independently count to ____.
*
Your answer
Please share any other information about your child that will help us ensure they have a positive Kindergarten experience.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of East Haddam Public Schools.
Report Abuse
Forms
