PARENT SURVEY

Child’s Name:______________________________ Birthday:____________________

Parents Names: ________________________________________________________
Contact Phone Number(s):_______________________________________________
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Email(s):_______________________________________________________________
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Address:_______________________________________________________________
Best Time to Contact: (circle best time)
Before School (7a-11a), Middle of the Day (12p-3p), or Evening (4pm-8pm)
Student Allergies/Health Concerns:________________________________________
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List Student’s Favorite Snacks/Foods:_____________________________________
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Emergency Contact (Name and Phone):____________________________________
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Student Strengths and Special Interests:_________________________________
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Where Would You Like To See Your Student Grow This Year:__________________
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What Motivates Your Student:____________________________________________
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Please List Who’s Allowed to Pick Up Your Child From School:__________________
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What Does Your Student Enjoy Doing at Home:_____________________________
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What Things Upset Your Student:_______________________________________
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Do You Have Access to Technology: YES NO
Is There Any Other Important Information You’d Like to Share:__________
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