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Early Learners Incoming Student Information Form 22-23
Thank you for taking the time to fill out this form which allows us to "get to know" your child before they enter our doors on the first day of school in the Fall. Knowing more about your child will also help us make thoughtful class placement decisions and set children up for a successful year in Early Learners!
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* Indicates required question
Parent First and Last Name(s)
*
Your answer
Child's First and Last Name
*
Your answer
What is your child's gender?
*
Male
Female
Other:
What is your child's date of birth?
*
MM
/
DD
/
YYYY
Does your child have a nickname you'd like us to use at school? Do you have any tips for pronouncing their name?
Your answer
Is this your first child at Early Learners?
*
Yes
No
Are there other languages spoken in your home? If so, what languages?
*
Your answer
Has your child attended another preschool?
*
Yes
No
If your child attended another preschool, what was the name of the program/school?
Your answer
What is your child’s elementary home school?
*
Kipling
Walden
Wilmot
South Park
List any allergies your child has. If none, write "none."
*
Your answer
List any Early Intervention Services your child has received. If none, select "none".
*
Speech
Developmental Therapy
Occupational Therapy
Physical Therapy
None
Required
How well does your child handle transitions from one activity to another?
*
Struggles to shift from one activity to another
1
2
3
4
5
Easily transitions from one activity to another
How would you describe your child's social interactions with peers?
*
My child struggles with peer interaction
1
2
3
4
5
My child interacts with peers appropriately (e.g. shares, takes turns, has many friends)
How well does your child follow multi-step directions?
*
Struggles to follow directions
1
2
3
4
5
Follow directions easily
My child stays interested in self-chosen activities for
*
My child stays interested in activities for 0-5 minutes
1
2
3
4
5
My child stays interested in activities for 20-25 minutes
When your child is asked to do something they don't want to do, how does he or she respond?
*
Struggles/Refuses to do what is asked
1
2
3
4
5
Responds by doing what is asked
Have there been any significant experiences in your child's life of which school should be aware of? (e.g., moves, deaths, significant events or changes)
Your answer
Has your child had any major illness or injury, or have any current medical condition we should be aware of?
*
Your answer
What do you feel are your child's strengths?
Your answer
What do you feel are your child's areas for growth?
Your answer
Please share if there is anything else that is important for us to know about your child.
Your answer
How best can we support your family this year?
Your answer
Thank you for providing this helpful information! We look forward to your child joining us in the fall!
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