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Help us get to know your child.
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* Indicates required question
Student's teacher?
*
Choose
Mrs. Covington
Mrs. Holm
Mr. Mendez
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Student's Nickname (if any)
Your answer
Who is completing this form?
*
mom
dad
grandma/grandpa/aunt/uncle
other
Student Birthday
*
MM
/
DD
/
YYYY
Student Age
*
Your answer
Home Address
*
Your answer
Student Lives With (click all that apply)
*
mom
dad
stepmom
stepdad
grandparent(s)
guardian
Required
Mother's Name
Your answer
Mother's Cell Phone Number
Your answer
Mother's Occupation/Job
Your answer
Mother's Work Phone Number
Your answer
Mother's E-mail Address
Your answer
Mother's Home Phone Number
Your answer
Father's Name
Your answer
Father's Cell Phone Number
Your answer
Father's Occupation/Job
Your answer
Father's Work Phone Number
Your answer
Father's E-mail Address
Your answer
Father's Home Phone Number
Your answer
After school, ____.
*
my child rides the bus.
my child is picked up.
my child goes to Think Together.
My child is participating virtually.
Required
If your child rides the bus, where do they get dropped off to? If your child is picked up, who picks them up and what is their phone number? If both of these do not apply, please type NA.
*
Your answer
Please list all brothers and sisters to include grade level (and teacher if you know). Thanks.
*
Your answer
Has your child ever repeated a grade? If yes, which grade?
*
NA/Never repeated a grade
TK/Preschool
K
1st grade
2nd grade
3rd grade
Required
In which grade did your child start at Seneca Elementary?
*
Headstart
TK
K
1st grade
2nd grade
3rd grade
Please list the name and city of any other school district(s) where your child has attended school.
*
Your answer
Does your child wear glasses?
*
Yes, all the time.
Yes, for reading close up.
Yes, for reading far away.
I think s/he might need glasses and will make a doctor appointment soon.
No, glasses aren't needed at this time.
How often did your child read this summer?
*
Daily
Weekly
Not at all
Are their any health problems or food allergies that I should be aware of?
*
Your answer
Have any of the following events happened recently?
*
Divorce
Separation
New sibling
Death
Parental Job Loss
Move
Trauma
Other
NA
Required
Does your child have access to the internet?
*
Yes
No
Sometimes
Does your child have his/her own library card?
*
Yes
No
List some of your child's interests/leisure activities/hobbies/what they like to do.
*
Your answer
What are your child's favorite toys or things they collect?
*
Your answer
What motivates your child?
*
Your answer
What upsets your child?
*
Your answer
What is your child really good at?
*
Your answer
What does your child need help with the most?
*
Your answer
Are there any holidays that your child does not celebrate?
*
Your answer
We love diversity. Are there any traditions or cultural celebrations that your family would like to share with the class this year?
*
Your answer
Please tell me anything you feel might help your child and I have a successful year together. Thank you for your time completing this form.
*
Your answer
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