(818) 341-1454
KINDERGARTEN PARENT
QUESTIONNAIRE
Child’s
Full Name ___________________________________________________________________________________________
(First) (Middle) (Last)
Address
___________________________________________________________________________________________________
Phone
No. ______________________________________________ Birth date
Other
Children in the Family Age Grade/School
SOCIAL EXPERIENCES
1. Has your child attended pre-school? If yes, how long?
What pre-school has your child attended?
2. Has your child
attended the Sunday Pre-School Program? ______________ If yes, how long?
____________
3. Does your child attend church with
you? _______________
4. Please check the
places your child has visited:
£
library £ farm £
factory £ mountains £ country fair
£
ocean £ museum
£
airport £ downtown £ zoo
5. Where has your child traveled?
6. How has your child
traveled?
7. Does
your child play quietly or actively?
8. Does
your child play mostly by himself/herself?
9. What
activities does your child enjoy outdoors?
10. Does your child enjoy watching
television?
11. What programs are his/her favorites?
12 What
activities does your child enjoy indoors?
13. Does your child enjoy books? If yes, what is his/her favorite?
14. Do you read to your child? How
often?
15. Is your child able to remember songs or
rhymes?
16. Has your child had experience with
paints? Crayons? Scissors?
DEVELOPMENT
1. Does your child
have any health problems the school should be aware of? If yes, what problems? Please explain.
2. Does your
child have any food allergies?
3. At what age
did your child walk alone? Feed self?
Talk in sentences?
4. Is your child
right-handed or left-handed?
5. Does your
child dress himself/herself?
6. Please check
what your child can do:
£ button £ tie shoes £ snap £ zip £ lace shoes
7.
Is
your child able to skip?
8.
Is
your child able to write his/her first name?
9.
Is
your child aware of dangers such as fire? electricity?________ traffic?_______ strangers?_______
10.
How
do you discipline your child?
11.
How
do you expect your child to be disciplined in school?
12.
Can
your child take care of his/her toilet needs?
13.
Does
your child wet the bed? Never Occasionally
Rarely
14.
Check
the characteristics that apply to your child:
£ Cries easily £ Whines £ Sulks £ Jealous
£ Temper Tantrums £ Fearful in new situations £ Destructive £ Daydreams
£ Eating problems £ Bites nails £ Easily Angered £ Sucks thumb
£ Does not like to share £ Sleeping problems £ None of these
15.
Describe
your child ________________________________________________________________________________________________________________________________________________________________
16.
What
is your child’s strength?
17.
What
is your child’s weakness?
18.
What
is your child’s bedtime?
19.
How
many hours of sleep does your child get each night?
20.
Does your child
take a nap? If yes, for how long?
SCHOOL
ADJUSTMENT YES NO
1.
Is your child able to sit still
and listen to a story for 5 – 10 minutes? £ £
2. Does your child listen without interrupting
while someone else talks? £ £
3.
Is your child able to share and take turns? £ £
4. Does your child know his/her
telephone number? £ £
5.
Does
your child know his/her home address? £ £
6. What do you expect your child to
acquire through the Kindergarten experience? ________________________________________________________________________________________________________________________________________________________________________
7.
What
language/s is spoken at your home?
8. What would you like your child to
learn concerning his/her religion?
9. What else would you like your child’s
teacher to know about your child? ________________________________________________________________________________________________________________________________________________________________________
BEFORE
AND AFTER SCHOOL CARE
1. Do you plan to
enroll your child in the Morning Extended Day Care? ______
Arrival Time __________
2. Do you plan to enroll your child in the
After School Extended Day Care? ______
Pick-up Time __________
Why do you want your child in a
parochial school?
Our
philosophy is that the parents are the primary educators of their
children. They reflect some of the
values of the school which you would be expected to share. Please initial the following statements.
FATHER MOTHER
1.
I will strive to witness
my faith by my Christian behavior,
attendance at church and help my child form Christian values. ________ ________
2.
I will teach my
child that choices have consequences and
help him/her to grow in self-discipline. ________ ________
3. I will support the school policies and regulations. ________ ________
Each year, we have
more applicants than we can accommodate.
Please understand
that we often turn away children
and families we would
love to take.
Thank you for your
understanding and may God bless you.