High Point Christian School Preschool Family Information Form
Email address *
Child's Name *
Your answer
Nickname
Your answer
Parent/Guardian #1 *
Your answer
Parent/Guardian #2 *
Your answer
This child was potty trained at age: *
Your answer
Has this child ever had a hearing test? *
Hearing test date
MM
/
DD
/
YYYY
Hearing test results
Has this child ever had an eye examination? *
Eye examination date
MM
/
DD
/
YYYY
Eye examination results
Your answer
Can this child: (mark all that apply) *
Required
Describe your child's favorite playmates (i.e. solitary, siblings, peers, adults) *
Your answer
Describe your child's favorite activities (i.e. toys, games, books) *
Your answer
Do you have a television? *
If yes, about how many hours is the television on each day?
Your answer
What are this child’s favorite television programs?
Your answer
Does anyone read stories to this child? *
If yes, who?
Your answer
How often?
Your answer
What is or will be your child’s routine on a school day? *
Your answer
Please take a moment to describe your child’s personality and temperament to us: *
Your answer
Please describe the type of discipline for behavior you use at home: *
Your answer
What makes your child angry or upset? *
Your answer
What calms your child when he/she is upset? *
Your answer
What things make your child happy? *
Your answer
What are three strengths you see in your child? *
Your answer
Are there religious or family/cultural traditions your child observes? *
If yes, please specify
Your answer
Please describe any unique circumstances in your family or child’s life that may affect your child’s current behavior? (For example: child’s imaginary playmate, new sibling, a recent move, problems with child care arrangements, family death, illness or hospitalization, parent separation or divorce, etc.) *
Your answer
Who are the important people in your child’s life not listed in previous admissions forms? *
Your answer
The child has attended (check all that apply) *
How has daytime childcare been provided in the past? (check all that apply) *
Required
Are there pets in the home? *
If yes, please specify:
Your answer
Is English your child's primary language? *
If no, what is the primary language?
Your answer
Describe your child's language and communication abilities:
Your answer
If English is the second language, how does your child communicate the following:
I need to use the bathroom
Your answer
I don't feel well or am sick
Your answer
I am tired
Your answer
I feel sad
Your answer
I am thirsty and need a drink
Your answer
Does your child have fears we should know about? *
If yes, please specify and provide tips for helping your child cope with them.
Your answer
What are your child's eating habits and routines? *
Your answer
What are your child's food likes and dislikes? *
Your answer
Does your child have a current Individual Education Plan (IEP)? *
If yes, please explain
Your answer
What do you hope your child gains from enrollment in our program?
Your answer
Thank you for your time and patience in filling out this questionnaire. Your responses will be held in the strictest confidence. Responses will be shared with the classroom teacher to enable us to meet your child's needs, concerns, and transition to school.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of High Point Church.