Flowery School Kindergarten Questionnaire
This information will be kept confidential.
Child's first and last name
Your answer
Name your child goes by
Your answer
Who is completing this questionnaire?
Child's birthdate
Your answer
Gender
Parents' first and last names
Your answer
Best phone number
Your answer
Name(s) of preschool(s) if attended (check all that apply)
How long was your child enrolled in preschool?
Your answer
Child's dominant or first language
Other languages your child speaks (if any)
Your answer
Who lives in your child's household?
Your answer
Is your child
List the names and ages of your child's siblings
Your answer
If they are in school, which schools do your child's siblings attend?
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?
Your answer
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?
Which materials does your child have experience using (check all that apply)?
Is your child able to say his/her birthdate?
Can your child say your phone number?
How often do you read to your child?
What is the title of your child's favorite book?
Your answer
How does your child typically choose to play when other children are around?
Approximately how much screen time does your child spend each day?
How is your child spending screen time (check all that apply)?
Do you monitor and limit screen time?
What programs does your child watch most regularly?
Your answer
What is your child's favorite movie?
Your answer
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?
Your answer
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?
What time does your child usually go to bed?
What are your child's greatest areas of interest?
Your answer
Is there anything else you would like us to know about your child that we did not ask?
Your answer
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