2018-2019 Family and Student Information
Please answer all of the following questions completely and accurately. The information provided will be used solely by Good Shepherd Lutheran Preschool and will remain confidential.
Email address *
Child's First Name *
Please enter your child's full first name as it appears on their birth certificate (i.e., no nicknames).
Your answer
Child's Middle Name
Please enter your child's full middle name as it appears on their birth certificate. Leave blank only if your child does not have a middle name.
Your answer
Child's Last Name *
Please enter your child's full last name as it appears on their birth certificate.
Your answer
Child's 2018-2019 Class *
Basic Information
Child's Preferred Name *
Please list your child's preferred name, nickname, or what he/she is usually called at home.
Your answer
Child's Place of Birth *
City, state, country
Your answer
Citizenship *
Is the child a U.S. citizen?
Neighborhood Elementary School
If known - the school where your child would attend kindergarten
Your answer
Family and Household Information
Parents' Marital Status *
What is the marital status for the child's parents? (Please note that if there is a custody agreement for the child, a copy must be on file in the Preschool Office.)
Parents' Residence *
Do both parents reside in the same household?
Describe Living Arrangements
If children do not live in the same household as both parents, please describe the living arrangements and custody details below.
Your answer
Other Household Members
Please list the names and ages (if under 21 years old) of others living in the household and their relationship to the GSLP student.
Your answer
Religious Belief *
Does your family profess a specific religious belief?
Religion
If you checked "Yes" above, please list your family's religion(s).
Your answer
Values and Traditions
GSLP values a diverse student body. Are there any cultural or religious values, beliefs, traditions, celebrations, or customs that are especially important to your family?
Your answer
Child-Rearing Practices
Please describe any culturally based child-rearing practices that may help staff members meet your child's needs.
Your answer
Child's Habits and Routines
Bedtime *
When does your child usually go to bed?
Time
:
Wake-Up Time *
When does your child usually get up in the morning?
Time
:
Naps *
Does your child nap during the day?
Nap Length
If your child naps, when does he/she nap and for how long?
Your answer
Toileting
Does your child have any special words, expressions, or actions concerning toileting habits that the teacher should know?
Your answer
Child's Experiences and Reactions
Separation from Caregivers *
Does your child have difficulty separating from you or the primary caregiver?
Easing Separation
Please describe any strategies you have used to help ease separating for your child.
Your answer
Other Programs *
Has your child participated in an early childhood program, daycare, playgroup, or class (sports, art, dance, music, language, Sunday School, faith formation, etc.) other than GSLP?
Describe Other Programs
Please describe any other programs your child has participated in.
Your answer
Reaction to Other Children *
How does your child respond in situations where other children are present?
Your answer
Fears *
What fears does your child have? How are they expressed?
Your answer
Frustration *
How does your child react when frustrated by a situation?
Your answer
Technology Access
Does your child have access to any of the following:
Child's Interests and Needs
Physical Activities *
My child enjoys the following physical activities:
Your answer
Toys and Games *
My child especially enjoys playing with these toys:
Your answer
Characters *
Some of my child’s favorite fictional characters (such as Thomas the Tank Engine, Minnie Mouse, Elmo, etc.) are:
Your answer
Other Likes *
My child likes the following things:
Your answer
Dislikes *
My child dislikes the following things:
Your answer
Skills *
Some things my child does well are:
Your answer
Skills in Progress *
I am working with my child on:
Your answer
Individual Needs *
My child might need help with:
Your answer
Hopes and Expectations *
Why did you enroll your child in preschool? What hopes and expectations do you have for your child as a result of his/her participation in the GSLP program?
Your answer
Additional Comments
Please include any additional information you think might be important for us to have.
Your answer
Electronic Signature *
Type your full name below to sign this form.
Your answer
Today's Date *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Good Shepherd Lutheran Preschool. Report Abuse - Terms of Service