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Parent Info Survey
Welcome to 4H! Please fill out this survey about your child with information that will help me to support your child this year. One survey per child please.
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Child's Name
*
Last, First
Your answer
Does your child go by a nickname? If so, please write it below.
i.e. Chris instead of Christopher
Your answer
Parent/Guardian Name:
*
Last, First (Main Contact Person)
Your answer
Parent/Guardian Name:
Last, First
Your answer
Please list any siblings and their ages. If they are at Country Trails, please include their class.
*
ex. Jamie 3R
Your answer
Who does the child live with?
*
Please check all that apply
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Aunt
Uncle
Cousins
Other:
Required
Does your child wear glasses?
*
Yes, all the time
Yes, for reading only
No
Other:
If your child IS supposed to be wearing classes, will he/she have a pair that is kept at school?
Yes
No
They wear their glasses at all times
Other:
Clear selection
Are there any languages (other than English) spoken at home?
*
Yes
No
If Yes, please specify language in "other" box.
Other:
Would you like to share information regarding religious background and/or holidays celebrated (or not celebrated)?
Your answer
Does your child participate in any extra curricular activities outside of school? If so, please share what activity and time of year (fall, spring, etc).
*
This helps me know if there is a busy time of year for them.
Your answer
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