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Parent Questionnaire
Thank you for taking the time to fill out this questionnaire.
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Email
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Your email
1. Name of child as it appears on the birth certificate (FIRST, MIDDLE, LAST)
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Your answer
2. By what name do you call your child?
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Your answer
3. What terminology does your child use regarding the use of the bathroom?
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Your answer
4. Has your child been tested for any disabilities or disorders that would be related to his or her learning in school?
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Your answer
5. If your child has attended preschool before, was the experience enjoyable? Why?
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Your answer
6. Does your child have any tantrums? What is/are the trigger/s?
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Your answer
7. Does your child suck his/her thumb or have any attachment to certain objects (e.g. blanket)? If yes, kindly specify.
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Your answer
8. If your child has unusual fears, what are they?
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Your answer
9. a. Does your child use the following at home? (Check all that apply)
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crayons
scissors
pencil
chalk
markers
Required
9. b. Which hand does your child use for the materials above?
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left hand
right hand
not yet determined
10. What kind of food does your child like?
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Your answer
11. What kind of food does your child dislike?
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Your answer
12. List the names and ages of other children in your family:
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Your answer
13. What do you see as your child’s strengths?
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Your answer
14. Is there any area in which you anticipate difficulty for your child? (e.g. sharing, following directions, etc.)
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Your answer
15. What immediate goals do you have for your child?
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Your answer
16. What other information would you like us to know about your child?
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Your answer
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Goodstart Educational Center (Goodstart Preschool).
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