Preschool Intake Form printable pdf download

Pathways to Play Early Learning Center

1815 Bromley Avenue

South Saint Paul, MN 55075

Preschool Intake Form

Child's Name: ______________________________________________

Date of Birth: ______________________________________________

Parent(s) Name(s): ___________________________________________

Does your child have any nicknames he/she likes or is used to? __________

_________________________________________________________

Has your child been in any group care situations before?

_________________________________________________________

What is the primary language spoken in your home? __________________

_________________________________________________________

Does your child have a difficult time separating from you? How does he/she

handle separation?___________________________________________

_________________________________________________________

Does your child have any siblings or close friend relationships? __________

_________________________________________________________

Does your child have any particular eating habits/patterns? ____________

_________________________________________________________

Does your child have any particular fears? _________________________

_________________________________________________________

How does your child like to be comforted when upset? ________________

_________________________________________________________

What are your child's interests and hobbies? _______________________

_________________________________________________________

What toy(s) does your child most like to play with? __________________

_________________________________________________________

Does your child have any particular sleeping habits/patterns? ___________

_________________________________________________________

**please fill out reverse side as well**

Pathways to Play ELC (651)414-0857 1815 Bromley Avenue, South Saint Paul, MN 55075

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Preschool Intake Form