ANECDOTAL RECORD OF A CHILD

NAME OF A CHILD:____________________________ DATE OF BIRTH:_____________________

PARENT’S NAME:
MOTHER:_____________________________ Educ’l. STATUS:______________________
FATHER:______________________________ Educ’l. STATUS:______________________

INFORMATION:
A. No. of sister(s):___________ Brother(s):__________

Place in the family

Eldest ( ) Middle ( ) Youngest ( )

Members staying with the family

Grandparents ( ) Uncle ( ) Aunt ( ) Helpers ( )

B. Age of Child in Grade I

5 ( ) 6 ( ) 7 ( ) 8( ) others:______

School record-last year

Passed ( ) Repeater ( ) Drop ( )

C. Child relationship to parents

Good ( ) Slightly Good ( ) Drop ( )

D. Child relationship to brothers/sisters

Good ( ) Slightly Good ( ) Drop ( )

E. Child’s remarkable traits

Obedient ( ) Slightly Good ( )

F. Interest of child
Play ( ) Study ( )

G. Study Habit
Always ( ) Sometimes ( ) Seldom ( )

H. Subject weakness
English ( ) Math ( ) Filipino ( ) Sibika ( ) Science ( ) Others ( )

I. Child’s defect
Eye ( ) Ears ( ) nose ( ) mental ( )
Health illness ( ) none ( )

J. Brief History of the child since birth

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 REMARKS

QUARTER 1
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Adviser PARENT/GUARDIAN
DATE: __________________ DATE: __________________________

QUARTER 2
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Adviser PARENT/GUARDIAN
DATE: __________________ DATE: __________________________

QUARTER 3
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Adviser PARENT/GUARDIAN
DATE: __________________ DATE: __________________________

QUARTER 4
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Adviser PARENT/GUARDIAN
DATE: __________________ DATE: __________________________