Student & Family Info

STUDENT INFORMATION SHEET

Email*

Child's First Name*

Child's Last Name*

Birthdate*

Parent/Guardian Information

Father's First Name*

Father's Last Name*

Father's Occupation*

Mother's First Name*

Mother's Last Name*

Mother's Occupation*

Parent's Marital Status*

Siblings (please list names, ages, in home or not)*

Please list any other persons living with the child and their relationship to the child if applicable. (Grandparents, aunts, uncles, etc.)*

Are there any family situations that affect the child (foster or step-parents, divorce, extended illness, etc.)

Child's Personal History

Handwriting*

Does your child have any allergies*

If you answered yes to allergies, please list and explain.

Does the child take any medication regularly (even over the counter)? If so, please list the medications and their purpose.*

Are there any medical problems that we need to be made aware of?

Is there any additional information that you would like to share with us?

Has your child had any other previous group or preschool experience?*

If you answered yes to other previous groups/preschools, please indicate where and when.

What play materials does your child use most?*

Do you regard your child as affectionate?*

How does your child respond in your absence?*

Pleasure:*

Unhappiness or Disappointment:*

Discipline:*

New Situation:*

How does your child show his/her anger or frustration?*

Is there any special information that you feel First Church Preschool should have which has not been included in the previous questions?*

Briefly tell us how you feel First Church Preschool will contribute to your child.*

Which Elementary school will your child attend?*

How did you hear about First Church Preschool?*