Pre-Nursery Questionnaire 
In order to become better acquainted with your child, we are asking you to fill out the questionnaire below.

This background will help your child’s teacher communicate with both you and your child in a more informed way and thus, we hope, make the school experience more meaningful from the very beginning of the year.
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FAMILY BACKGROUND
Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Parent's (Preferred) Names *
Siblings: Names & Ages
Name of Caretaker outside of the family
Are there any other languages spoken at home?
What holidays/traditions does your family celebrate?
What special activities do you with your family?
HEALTH
Has your child had any serious illnesses/accidents or been hospitalized? Please describe
Does your child have any allergies?
Does your child have any physical challenges?
Does your child have any hearing or vision difficulties?
Describe your child's attitude to eating.
What is your child's bedtime routine?
DEVELOPMENT
Has your child ever been evaluated for any developmental delay? Please describe.
Has your child received any special services (PT, OT, speech, etc...)?
Does your child have any particular fears?

Please describe how your child handles transitions.
Please describe your child's temperament.
How often do you read to your child?
What is his/her favorite book?
What are your child's favorite activities or interests?
What are your child's best qualities and strengths?
Have any important events occurred recently or is there any other information you would like to share with your child's teachers?
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