475 Longleaf Pine Parkway St. Johns, FL 32259 (904) 547-4050

Patriot OaksAcademy

475 Longleaf Pine Parkway  St. Johns, FL 32259  (904) 547-4050

KINDERGARTEN STUDENT INFORMATION 2018-19

Please remember that this questionnaire is intended as an aid to help with class placement. The information you provide helps Administration find the best kindergarten teacher for your child. Please note that we cannot honor specific teacher requests. Thank you for your input.

Student Name: ______Also goes by: ______

Age: ______Gender: ______Date of Birth: ______

Student Address: ______Phone #: ______

Mother’s Name: ______Father’s Name: ______

Address: ______Address: ______

Contact Number: ______Contact Number: ______

Email: ______Email: ______

Guardian’s Name: ______Child Resides with:

Address: ______Both parentsMother

Contact Number: ______FatherOther ______

Email: ______

Siblings (name, age, school): ______

PRE-SCHOOL INFORMATION

Check all options that apply to your child. My child participated in:

Full-time pre-school/daycarePart-time pre-school/daycare

Play group(s)In-home childcare

If Yes to any of the above, please list name/location: ______

BASIC SKILLS

My child is able to read:IndependentlyWith guidanceNot yet

Able to write name:Yes, in orderYes, in random orderNo

Recognizes numbers:Yes, in orderYes, randomlyNo

Able to count 0-20:YesNo

Recognizes letters:Yes, in orderYes, randomlyNo

Recites the alphabet:YesNo

Can sound and blend words (can, hat, fox):YesNo

Identify letter sounds:YesNo

Knows rhyming words:YesNoIdentify basic colors: Yes No

Follows 2-step instructions:YesNoIdentify basic shapes:Yes No

Knows his/her right and left: YesNoWill sit and listen to stories:Yes No

ADDITIONAL INFORMATION

My child is (check all that apply):

ShyTalkativeQuietSelf-ConfidentShares well with others

ActiveOutgoingVerbalExpressive

How would you describe your child? ______

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What are your child’s strengths and interests: ______

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Does your child currently receive any special services? If yes, what type? ______

______

This year in Kindergarten, I would like for my child to: ______

______

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Does your child have any allergies?YesNoIf yes, please explain: ______

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Please add additional comments that you would like us to know about your child: ______

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