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Student's Name: ______________________

Hello! I am so excited to
Birthday & Age: ________________________
have your child in class.
Please take some time to fill Parents'/Guardians' Names: __________
this out so I can get to know _________________________________________
your child!
Phone #: _______________________________

Child Info
Email: __________________________________
Friends: ____________________________
_____________________________________ Academic Info
Siblings: ____________________________
Strengths: ____________________________
_____________________________________
________________________________________
Favorite color: _____________________
________________________________________
Favorite treat: ______________________
________________________________________
Favorite book(s): ___________________
________________________________________
_____________________________________
Concerns: _____________________________
Favorite movie(s): __________________
________________________________________
_____________________________________
________________________________________
Fears/anxieties: ____________________
________________________________________
_____________________________________
________________________________________
Does your child have an IEP? ________
Hobbies and Interests What would you like your child to
achieve this year? _____________________
________________________________________
________________________________________
________________________________________
Comments: ___________________________
________________________________________
________________________________________
________________________________________

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