Kindergarten Student Information Form 2019-2020
All information is confidential. For Pine Ridge incoming Kindergarten Students Only
Child's Name *
Your answer
Name child likes to be called and writes *
Your answer
Age as of October 1st (________years, _______months) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Home address (You can enter more than one.) *
Your answer
Child lives with *
Guardian #1 Name *
Your answer
Guardian #1 Phone Number *
Your answer
Guardian #1 Email Address *
Your answer
Guardian #2 Name *
Your answer
Guardian #2 Phone Number
Your answer
Guardian #2 Email Address *
Your answer
Siblings - Please list names and ages. *
Your answer
Did your child attend Preschool? *
Name of Preschool *
Your answer
Number of years attended *
Your answer
Times per week attended *
Your answer
Pets - Please list the type and name of any pets in your home. *
Your answer
Allergies *
Your answer
Medications
Your answer
What would you like us to know about your child's health history?
Your answer
Hand preference *
Has your child been screened by Cherry Creek Child Find? *
Has your child been screened by an outside agency? (If yes, please list where after "other".) *
Is your child currently receiving any special service assistance? *
If yes, please check all that apply:
Have there been any recent, major changes in your child's life?
Your answer
Is more than one language spoken in your home? If yes, please list after "other". *
Are there any holidays or celebrations in which you do not want your child to take part?
Your answer
What indoor activities does your child enjoy? *
Your answer
What outdoor activities does your child enjoy? *
Your answer
What are your child's strengths and talents? *
Your answer
What is difficult for your child? *
Your answer
How well does your child make friends? *
Your answer
Can your child tie his/her own shoelaces? *
Can your child take care of his/her toilet needs? *
Can your child zip or button a coat and put on boots? *
Can your child put together a simple puzzle? *
Can your child pay attention to a short story when it is read? *
Can your child answer simple questions about the story? *
Can your child draw and color beyond a simple scribble? *
Can your child use scissors to cut on various types of lines? *
Can your child name and recognize colors? *
Can your child name and recognize numbers 1 to 10? *
Can your child count to 10?
Can your child repeat an 8 to 10 word sentence? *
Can your child remember and follow 2 and 3 step directions? *
Can your child recognize the ABC's (Upper Case Letters)? *
Can your child recognize the abc's (lower case letters)? *
Can your child read some simple words, signs or labels? *
Can your child read a book or a story? *
Can your child hold a pencil correctly? *
Do you read to your child daily? *
Is your child afraid of anything? If yes, please list. *
Your answer
Please share anything else that you feel is important for us to know about your child.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Cherry Creek School District. Report Abuse - Terms of Service