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Family Survey

Welcome to second grade! This information sheet is to help me better understand your child. Please be honest and provide details where necessary. Thank you for your time!

  1. Student Name: __________________________________ Date of Birth: __________________________
  2. Name of Parent(s) / Guardian (s):�____________________________________________________________________________________________
  3. Provide contact information below. Circle the best way for you to be contacted if needed.

Home Phone(s) _________________________________________________________________________________

Email(s): ________________________________________________________________________________________�Cell Number(s): _________________________________________________________________________________�Work Number(s): _______________________________________________________________________________

  1. Are any languages other than English spoken at home? ______________________________________
  2. What is the primary way your child will go home each day? __________________________________�*Please send a note if there are going to be any changes in dismissal.
  3. Do you have any special concerns about your child? (academically, socially, medically, etc.)�__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
  4. Please list any foods, stings, etc., that may cause allergic reactions with your child:�______________________________________________________________________________________________
  5. Please list one goal you would like to set for your child this year:�____________________________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________________

  1. Please tell me, in one million words or less, if there is anything else I should know about your child. Feel free to brag! Use the back if you need to. ☺ �______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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