My Preschool Child Page 2
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1
2Physical Skills Development
My child:
Yes
Sometimes
No
Plays with clay or playdough
Cuts with scissors
Puts 6-piece puzzles together regularly
Climbs on playground equipment
Rides a tricycle
Plays with blocks
Catches a ball
Enjoys paper/pencil/crayon activities
What is your child's favorite indoor activity?
What is your child's favorite outdoor activity?
Social-Emotional Development
My child:
Yes
Sometimes
No
Looks you in the eye for more than a few seconds
_____
_____
_____
Separates from parents easily
_____
_____
_____
Responds positively to change in routine
_____
_____
_____
Relates easily with most adults
_____
_____
_____
Takes turns with other children
_____
_____
_____
Plays cooperatively with other children
_____
_____
_____
Stays with an activity for at least 10 minutes
_____
_____
_____
(not video games)
Handles frustration well
_____
_____
_____
Falls asleep easily at night at regular bed time
_____
_____
_____
Undresses self without help
_____
_____
_____
Dresses self without help
_____
_____
_____
Takes care of personal needs (toileting, wash & dry hands)
_____
_____
_____
Feeds self regularly, using spoon and fork
_____
_____
_____
Eats dinner regularly at the same table with the family
_____
_____
_____
How many hours per day does your child watch TV, videos, or play video games? ________________
How often does your child play with other children? __________________________________________
What age child does your child play with most frequently? _____________________________________
Has anyone ever had any reasons for concerns about your child’s behavior? (Please explain) ________
___________________________________________________________________
What do you like to do with your child? ______________________________________________________
What things can your child do well? _________________________________________________________
What things are difficult for your child? _____________________________________________________
Does your child have any fears? If yes, please explain__________________________________________
How does your child express anger? _________________________________________________________
Is your child a foster child or is your child adopted? ___________________________________________
What else would you like the teacher to know about your child?
Form completed by
Date
Rev. 2016
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