Flowery School Kindergarten Questionnaire
This information will be kept confidential.
Child's first and last name
Name your child goes by
Who is completing this questionnaire?
Parents' first and last names
Best phone number
Name(s) of preschool(s) if attended (check all that apply)
El Verano Preschool
Little Shepherd Preschool
Montessori School of Sonoma
Old Adobe School
The Little School
Valley of the Moon Nursery School
My child did not attend preschool
How long was your child enrolled in preschool?
Child's dominant or first language
Other languages your child speaks (if any)
Who lives in your child's household?
Is your child
the oldest child
a middle child
the youngest child
an only child
List the names and ages of your child's siblings
If they are in school, which schools do your child's siblings attend?
Sonoma Valley High School
Can your child say his/her full name clearly?
Can your child write his/her name without help?
Does your child speak in complete sentences?
How high can your child count without help and without making a mistake?
Which colors can your child identify (check all that apply)?
Which shapes can your child identify (check all that apply)?
Does your child know how to use scissors?
yes, very well
Which materials does your child have experience using (check all that apply)?
Is your child able to say his/her birthdate?
yes, day and month
Can your child say your phone number?
How often do you read to your child?
a few times a week
once a week
a few times a month
I don't read to my child
What is the title of your child's favorite book?
How does your child typically choose to play when other children are around?
Approximately how much screen time does your child spend each day?
none, I don't allow screen time.
less than an hour
about 2 hours
more than 2 hours
How is your child spending screen time (check all that apply)?
watching educational programs
playing educational games
playing video games
Do you monitor and limit screen time?
What programs does your child watch most regularly?
What is your child's favorite movie?
Which places has your child visited (check all that apply)?
How does your child react when s/he has to be separated from you to go to preschool or stay with a babysitter?
Can your child button clothing?
Can your child put on shoes?
Can your child tie shoe laces?
Can your child zip zippers?
Is your child left or right handed?
I'm not sure
What time does your child usually go to bed?
After 9:00 p.m.
What are your child's greatest areas of interest?
Is there anything else you would like us to know about your child that we did not ask?
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This form was created inside of Sonoma Valley Unified School District.