Preschool Student Information Sheet printable pdf download

Preschool Student Information Sheet

PRESCHOOL STUDENT

INFORMATION SHEET

Child’s name: ___________________________________________________________

Mother’s name: _________________________Father’s name: _____________________

Sitter’s name: (if applicable) _________________________________ Phone: _________

Sitter’s address: __________________________________________________________

List all children’s allergies:

List all special medication:

List all restrictions/limitations:

Church membership: Timothy

No Church

Other (specify): __________________

Pastors Name: ___________________________________________________________

Has child been baptized? ________________ If so, when? _______________________

How did you hear about our program? ________________________________________

Has child been in a Preschool/Childcare/Children’s Day Out Program before? _________

If so, where? _____________________________________________________________

Child has received or been evaluated for the following:

____speech

_____hearing

_____vision

_____behavior

_____physical

Please explain_____________________________________________________________

________________________________________________________________________

Is there any family concerns we should be aware of, such as, a new baby, a death in the family,

or a divorce? _______________________________________________________________

__________________________________________________________________________

Are there any sensitive issues we should be aware of? Is your child self-conscious about his/her

appearance, is he/she shy, stutters, or afraid of something in particular?

Preschool Student Information Sheet