Getting to Know You Questionnaire

Please complete the questionnnaire about your child (for preschool families only):

Child's Name:*

Answer required for "Child's Name:"

Child's Pronouns*

Answer required for "Child's Pronouns"

Name child prefers to be called:

Answer required for "Name child prefers to be called:"

Date of birth:*

Answer required for "Date of birth:"

Parent/Guardian #1 Name:*

Answer required for "Parent/Guardian #1 Name:"

Parent/Guardian #1 Occupation:

Answer required for "Parent/Guardian #1 Occupation:"

Parent/Guardian #2 Name:

Answer required for "Parent/Guardian #2 Name:"

Parent/Guardian #2 Occupation:

Answer required for "Parent/Guardian #2 Occupation:"

Are there any other parents/guardians/relatives living in the household with your child?

Answer required for "Are there any other parents/guardians/relatives living in the household with your child?"

Is English your child's first language?*

Answer required for "Is English your child's first language?"

Yes

What is your child's secondary language?

Answer required for "What is your child's secondary language?"

Is there any information about your family that you believe would be useful in caring for your child (i.e. separated parents, cultural traditions, family situations, etc...)?

Answer required for "Is there any information about your family that you believe would be useful in caring for your child (i.e. separated parents, cultural traditions, family situations, etc...)?"

Does your child have any medical conditions that we should know about (i.e. asthma, seizures, etc...)?

Answer required for "Does your child have any medical conditions that we should know about (i.e. asthma, seizures, etc...)?"

Is your child required to take medication for these things? If so, please explain:

Answer required for "Is your child required to take medication for these things? If so, please explain: "

Does your child get frequent colds, earaches, fevers, sore throats, stomach aches, vision problems, or skin rashes?

Answer required for "Does your child get frequent colds, earaches, fevers, sore throats, stomach aches, vision problems, or skin rashes? "

Is your child potty trained?*

Answer required for "Is your child potty trained?"

Yes

What age did they start?

Answer required for "What age did they start?"

Please describe any assistance they may need:

Answer required for "Please describe any assistance they may need:"

Does your child take regular naps at home?*

Answer required for "Does your child take regular naps at home?"

Yes

What time do they go to bed at night?*

Answer required for "What time do they go to bed at night?"

Has your child had group play experiences?*

Answer required for "Has your child had group play experiences?"

Yes

Does your child like to play alone, with adults, or with other children?*

Answer required for "Does your child like to play alone, with adults, or with other children?"

How does your child relate to adults?*

Answer required for "How does your child relate to adults?"

Which activities has your child experienced? (check all that apply)*

Answer required for "Which activities has your child experienced? (check all that apply)"

Playdough

Glue

Scissors

Blocks

Painting

Puzzles

Other:

What’s your child’s favorite activity at home? *

Answer required for "What’s your child’s favorite activity at home? "

When and how does your child express frustration?*

Answer required for "When and how does your child express frustration?"

When and how does your child express anger? *

Answer required for "When and how does your child express anger? "

When and how does your child express fear? *

Answer required for "When and how does your child express fear? "

Does your child have any special fears? (dogs, loud noises, etc…) *

Answer required for "Does your child have any special fears? (dogs, loud noises, etc…) "

Does your child use electronics at home? (cell phones, tablets, video games, television, etc...)*

Answer required for "Does your child use electronics at home? (cell phones, tablets, video games, television, etc...)"

Does your child accept direction easily? *

Answer required for "Does your child accept direction easily? "

Describe your child’s attention span: *

Answer required for "Describe your child’s attention span: "

Describe your child’s personality and behavior: *

Answer required for "Describe your child’s personality and behavior: "

What kind of discipline do you find most effective at home? *

Answer required for "What kind of discipline do you find most effective at home? "

Do you have any concerns about your child’s development or behavior? *

Answer required for "Do you have any concerns about your child’s development or behavior? "

Thank you for completing this questionnaire!

Please fix the highlighted areas below before submitting.

Getting to Know You Questionnaire