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CHILD PROFILE (4'S & KINDERGARTEN)

Please complete the form below using "none or n/a" as needed.

Date*

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Child's Full Name*

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Assigned Class*

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Name to be used in class*

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Names and ages of siblings*

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Introduce us to your child!

SOCIAL

Child's previous school/daycare experience*

Please specify location and number of years, or type N/A if none)

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What opportunities does your child have to play with others the same age?*

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What discipline strategies are used with your child?*

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Has your child experienced any recent significant stresses? If yes, please briefly describe how your child has reacted to this stress. If no, please type N/A.*

( new sibling, move to a new home, new pet or death of a pet, separation, divorce or death of a relative or friend, etc)

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HEALTH

Are there any food allergies, dietary concerns/dislikes?*

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Please briefly describe your child's sleeping patterns. *

(bedtime, wake up time, nap, if any

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Please list any regular medications and dosage schedule.*

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Please list any special needs or services your child receives. Please identify type of service, frequency and provider. If none, please type "none".*

(speech therapy, occupational therapy, etc)

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Please check any or all of the personality traits listed below that apply to your child.*

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Shy/Reserved

Observer

Affectionate

Anxious

Sensitive/frightens easily

Active

Outgoing/curious

Demonstrative

Cautious

Please list any concerns you may have about your child's development. If none, please type "none".*

(social skills, gross motor or fine motor skills, language, cognitive, etc)

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Is there any additional information we should know in order for us to get to know your child better? If no, please type "no".*

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What do you hope your child will gain from the preschool or Kindergarten experience this year?*

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Name of parent completing form.*

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