What is your child's birthdate? (Month/Date/Year) *
Your answer
What is your address? *
Your answer
Parent/Guardian's full name: *
Your answer
Phone number: *
Your answer
Preschool Experience
List the preschools or other child care programs attended. Include the dates of attendance and the approximate number of hours per week attended.
Name of School/Program, Date of Attendance, Number of Hours Per Week: *
Your answer
Name of School/Program, Date of Attendance, Number of Hours Per Week:
Your answer
Name of School/Program, Date of Attendance, Number of Hours Per Week:
Your answer
Name of School/Program, Date of Attendance, Number of Hours Per Week:
Your answer
Parent Checklist
This checklist will help to determine your child's readiness to enter school at an early age. Please read each statement and indicate your child's abilities as listed by checking the appropriate response.