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Incoming Kindergarten Parent Questionnaire

Student Name:_____________________________ DOB: ________


Guardian Information
Mothers name: _______________________ Home phone: _______
Mailing address:__________________________________________
Place of employment: _____________________________________
Work phone:____________
Fathers name: _______________________ Home phone: _______
Mailing address: _________________________________________
Place of employment:______________________________________
Work phone: _____________
Number of siblings in family: _______
Names and DOB: ____________________

__________

____________________

__________

____________________

__________

____________________

__________

Student Information
Previous School: _____________________________
Does your child have IEP or 504? ___________________
Has your child received special services in previous schools attended? (speech, ESL,
resource room or gifted program)
_______________________________________________

Does your child have any special interest or talents that we should be aware of?
_______________________________________________________________________
_______________________________________
Does your child have any specific learning needs that you know of?
_______________________________________________________________________
_______________________________________
Does your child need special accommodations in the classroom?
_______________________________________________________________________
_______________________________________
How does your child feel about coming to school?
_______________________________________________________________________
_______________________________________
Does your child have any fears about school?
_______________________________________________________________________
_______________________________________
Is there any other information that you think we should know about your child?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______
Signed: ______________________________ Date: ____________

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