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Parent Survey
Please complete the following confidential form. This will allow me to have contact information all in one place. Input about your child will be helpful to me when planning lessons and motivating students. Thanks for taking the time. I look forward to learning with your child this year.
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* Indicates required question
Email
*
Your email
Child's last name
*
e.g., Smith
Your answer
Child's first name
*
Your answer
Parent / Guardian #1 (Primary Contact)
*
Enter first and last name (e.g. John Smith)
Your answer
Relationship of Parent / Guardian #1 (Primary Contact) to Student
*
Mother
Father
Step-Mother
Step-Father
Other:
Parent / Guardian #1 (Primary Contact) Daytime Telephone
*
Your answer
Parent / Guardian #1 (Primary Contact) E-mail
*
Your answer
Parent / Guardian #1 preference for short messages and reminders. Please enter phone number if prefer a text message or email address if prefer an email message.
*
Your answer
Parent / Guardian # 2
Enter first and last name (e.g., John Smith)
Your answer
Relationship of Parent / Guardian #2 to Student
Mother
Father
Step Mother
Step Father
Other:
Clear selection
Parent / Guardian #2 Daytime Telephone
Your answer
Parent / Guardian #2 E-mail
Your answer
Parent / Guardian #2 preference for short messages and reminders. Please enter phone number if prefer a text message or email address if prefer an email message. Enter "none" if you do not want to receive short messages and reminders.
Your answer
Photography
*
Do you give consent for your child's photograph to appear on our class website?
Yes
No
Can I add you to the parent email list? If so, you will receive an email a couple of times a month about classroom activities, homework assignments and field trip information.
*
Yes, both guardians
Yes, just guardian #1
Yes, just guardian #2
No
Other:
Living Arrangements
Are there any custody issues or living arrangements that you would like me to be aware of?
Your answer
Medical
Does the student have any medical issues that I should be aware of to ensure their safety?
Your answer
Clubs and Activities
Is your child involved in any clubs/activities/sports outside of school?
Your answer
Child's Strengths
What do you consider are some of your child's strengths?
Your answer
Child's Struggles
What do you think your child struggles with or finds challenging?
Your answer
Reading
Does your child read regularly at home?
Your answer
Student Success
As your child's teacher, what do you think is the most important thing I should know about him/her to be the best possible teacher for him/her?
Your answer
Other information?
Is there any additional information you feel is important for me to be aware of?
Your answer
Send me a copy of my responses.
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