2020/21 Wenonah Preschool Information Form
Eligible children must be 4 years of age by October 1, 2020. Children cannot be older than 5 years of age by October 1, 2020.
Please bring the following items to the Preschool Round Up:
• Birth Certificate
• Proof of Immunization
• Last Doctor’s Physical
• Proofs of Residency – mortgage or lease and utility bill
Child's Name *
Your answer
Child's Date of Birth *
Your answer
Parent/Guardian Names *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Does your child have any allergies? *
If yes, please list all allergies. *
Your answer
Has your child ever received early intervention services? *
If yes, please list what services your child received. *
Your answer
What are your preschool needs? *
If full day is not available due to limited interest, would you still enroll your child into Wenonah Elementary preschool program? *
Has your child attended another school or daycare program? *
If yes, where and how many days a week? *
Your answer
Child’s Siblings (Names and Age): *
Your answer
What is your child interested in? *
Your answer
What is your child’s favorite activity? *
Your answer
What are some things your child dislikes? *
Your answer
Is there anything else you want to tell us about your child before they start school? *
Your answer
Positive Social Relationships *
Always
Usually
Rarely
Never
Does your child play/talk with adults outside of your immediate family?
Does your child play/talk with children of about the same age outside of your immediate family?
Does your child play nicely with other children?
Does your child follow rules when playing games with others?
Are you able to leave your child with a sitter, friend, or relative without him/her crying for you?
Does your child express emotions (happy, sad, mad) appropriately?
Acquiring and using Knowledge and Skills *
Always
Usually
Rarely
Never
Can your child sing simple songs or nursery rhymes?
Can your child name colors and shapes?
Can your child identify some letters and numerals?
Can your child count to 10 or higher?
Does your child problem solve?
Does your child like to listen to books?
Taking Appropriate Action to Meet Needs *
Always
Usually
Rarely
Never
Does your child use a fork and spoon when eating?
When getting dressed, can your child put on shirt, pants, socks, and shoes?
Can your child peddle a tricycle or bicycle?
Is your child fully potty trained?
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