Kindergarten Parent Questionnaire "*" indicates required fields Thank you for taking the time to thoroughly complete the questions below. The information you provide will assist our administrators and educators in learning about your child and their specific needs in a classroom setting. Please complete all questions and submit as soon as possible. We look forward to partnering with you.Child's Name* Date of Birth* Name Child Uses* Language Spoken at Home* Gender* Male Female Home LifePlease list the names and ages of your child’s brothers and sisters, or other children in the home.*What are your child’s interests?*Does your child have any allergies? Please list.*What responsibilities does your child have at home?*What type of reading activities does your child engage in at home?*Does your family have special celebrations that you would like to share with the class?*SocialIs your child currently enrolled in an in-person preschool program?* Yes No Please list the name of the preschool and number of years attended.*How does your child handle transitions and new situations?*Are there any situations in which your child becomes particularly excitable, upset, frightened, overwhelmed or impulsive?* Yes No Please provide details.*How long does your child maintain interest in play, an activity, or a game at a given time?*What does your child know about numbers, shapes, and patterns?*What kinds of experiences has your child had with writing and writing tools?*What experiences has your child had that have required separating from you?*How does your child interact with other children? Please explain and consider whether or not your child shares, takes turns, and cooperates with peers.*Please list any group experiences that your child has had (day care, camp, church, library etc.)*What are your expectations for the Kindergarten program? What specific things would you like to see happen this year?*Please check characteristics/personality traits that describe your child. Comfortable in new surroundings Easily upset Friendly Quiet Clumsy Needs a lot of attention Impulsive Slow to warm up Clingy Seeks others to play with Has temper tantrums Smiles a lot Overstimulated by noise Prefers to play/be alone Gets along well with others Good-natured Has difficulty sleeping Right-handed Left-handed Sucks thumb Shy Fearful Easy going Asks for help when needed Developmental HistoryDescribe any special circumstances/health problems, which have affected your child’s development or performance in school. (For example: severe allergies, illness, ear infections, particular learning, or attention difficulties, etc.) Please explain.*Do you have concerns about any area of your child’s development? Please explain.*Describe any developmental evaluation/screening your child has received (Hearing, vision, neurological, speech, occupational or physical therapy, Autism services, Behavior Therapist, Psychologist/Psychiatrist etc.)*Final ThoughtsPlease share any information about your child that you feel will help us work together with you in assessing if Walnut Grove Christian School is the right educational fit for your child and family. Please list concerns, questions, comments, or any other information you feel is pertinent to your child and your family’s goals for a kindergarten program.*Walnut Grove Christian School abides by the Family Educational Rights and Privacy Act (FERPA).The information provided in this questionnaire will not be disclosed to individuals outside of the child’s educational team. To the best of my knowledge, the above statements are true and accurate.* Agree Disagree Completed By (Print Name)* Relationship to Child* Digital Signature By typing your name into the digital signature field, you are submitting a digital signature as if you had signed with ink. The Electronic Signature Act of 2000 makes digital signatures legally actionable. The date and your IP address will be captured.