2019 Kindergarten Screening: Parent/Guardian Survey
This survey is for parents/guardians of children who will attend the Clara Barton Elementary School in the fall.
Your input on this survey is greatly appreciated. Please complete all items as best as possible.
Please provide your child's last name *
Your answer
Please provide your child's first name *
Your answer
Please provide your name *
Your answer
Please check your relationship to the child *
If "Other" is selected, please type in your response in the box provided.
Please check the box which most accurately describes your child in each situation
Not Yet
Plays with other children
Uses words to express anger
Waits his/her turn
Shares with others
Completes tasks when asked the first time
Works independently
Plays independently
Enjoys having books read to him/her
Tells a story about a past event
Dresses himself/herself (e.g., buttons, zipper, snaps)
Uses the bathroom independently
How does your child typically react when he/she does not get their way?
If "Other" is selected, please type a brief description in the box provided.
Did your child attend Pre-School?
If you answered "Yes" to the question above, please provide the name of the Pre-School.
Your answer
What is the primary language spoken at home?
If "Other" is selected, please type in the name of the language.
Does your child speak any language other than English?
If you answered "Yes" to the question above, please provide the language(s) your child speaks in the space below.
Your answer
Has your child received (or is receiving) any special services (e.g., Speech, Occupational or Physical Therapy)?
If you answered "Yes" to the question above, please describe the services he/she receives.
Please include the type, frequency and duration of the services. For example, speech/ three times a week/ 30 minutes at a time
Your answer
Our Kindergarten Readiness Night is being held on Thursday, June 13th @ 6:30 pm
This parent workshop will be held in the all purpose room at the Peter Muschal School. ALL parents of incoming kindergarten students are encouraged to attend.
Please provide a current email address where we can send you information regarding our Kindergarten Readiness Night even if you are unable to attend.
Your answer
Please use the space below to provide any other information that you feel will help our school best serve your child.
Your answer
Thank You!
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