Teacher / Child Care Questionnaire
This form is to be completed by the child's current or past teacher or child care provider.

I have permission from the child's parent/ guardian to provide information to Boulder Valley Waldorf School regarding this child's school performance and attendance. All information provided will be kept confidential.

Child's Information
Child's Name *
Your answer
Child's Birthdate *
MM
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DD
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YYYY
Child's Gender *
Current/Previous Teacher's Name: *
Your answer
Position: *
Your answer
Name of Program/School *
Your answer
Size of Group: *
Your answer
Date child started program: *
MM
/
DD
/
YYYY
Please describe the child's disposition. Does it change during the day? Week? *
Your answer
How does he/she relate to other children and teachers? *
Your answer
What is the biggest challenge you have had in working with this child? The most wonderful aspect? *
Your answer
Please describe the relationship to the parent, their involvement with your program and their responsiveness to both their child and your concerns.
Your answer
Feel free to add any other information you think would be helpful for us to know.
Your answer
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This form was created inside of Shepherd Valley Waldorf School.