Help Us Know Your Child! – Ward Preschool

My child is a…*

3 Year Old
4 Year Old
Young 5

Child’s Birthdate*

Gender*

Male
Female

Name of Child*

What name do you want your child to write/recognize in class?*

Mother’s Name*

Father’s Name*

LIST AND EXPLAIN ANY AND ALL ALLERGIES*

MY CHILD WILL HAVE AN EPI-PEN AT SCHOOL*

Yes
No

Was your child premature?*

Yes
No

People in home*

Mother
Father
Other Adults

Other children, specify names & ages*

Language(s) spoken at home?*

Occupation of Mother / Guardian*

Occupation of Father / Guardian*

Has your child had previous preschool experience?*

Great! Where did your child attend?*

Describe your child’s responsibilities at home*

Does your child have any pets?*

Types of animals & names*

Does your child have any fears or anxieties?*

Please specify*

Do you feel your child is advanced in some areas?*

Do you feel your child is delayed in some areas?*

Does your child have any limitations that we should be aware of?*

Does your child tend to be*

right-handed
left-handed
both
not sure

List some specific behavior traits you have observed in your child such as shyness, outgoing, rebellious, etc.*

Do you have any specific concerns about your child entering preschool?*

List email addresses you would like to receive weekly classroom email communication:*

List whom regularly will be dropping off/picking up your child(ren):*

Do you have any specific concerns about your child entering preschool? Please use this space for additional comments which might be helpful to us in getting to know your child. Thank you!*