Personal Data Form printable pdf download

Personal Data Form

Child’s Name________________________________________________________________

First

Last

Name your child prefers to be called___________________________________

Does your child play with other children regularly?__________________________________

What kind of group activities has your child participated in and for how long?

Preschool_______________ Sunday School ________________ Day Care______________

Story Hour ______________ ECFE__________ Recreation_________ Other_____________

Does your child have difficulty separating from you?

Is your child right handed? _____ left handed?_______ undecided?________

Has your child used crayons?______ paint?______ scissors?________ playdough?_________

How would you describe your child?

What are some of your child’s interests?

What makes your child frustrated?

Types of discipline used in your home:

Does your child have any physical, behavioral, emotional, intellectual or speech delays not

common to his or her age level? Please explain any concerns you may have.

Please state any other information that would be helpful to us in understanding and working with

your child.

As a parent, what would you like your child to get out of this preschool experience?

Personal Data Form