Lil Highlander Preschool
at McKean High School
Child Information Card
Child’s Full Name ______
M_____F_____ Date of Birth______
Name you prefer your child to be called in school:______
Name of Parent/Guardian: / Name of Parent/Guardian:Relationship to Child: / Relationship to Child:
Address: / Address:
Home Phone #: / Home Phone #:
Cell Phone #: / Cell Phone #
Place of Employment:
Occupation: / Place of Employment:
Occupation:
Work Phone #: / Work Phone #:
Email: / Email:
Status of Parents: (check all that apply) ___Living Together ___Living Separately
___Married ___Divorced
Child Lives with: (List all names of people living in household and relationship to child. If sibling list age)
Persons other than parent/guardian authorized by you to pick up your child (Photo Identification with name and address will be required of them). List in order of preferred contact:
Name / Address / Relationship to ChildPhysical Development and Background
Child’s Pediatrician______Phone ______
Has your child had any serious illnesses, accidents or hospital experiences?______
If so, please list:______
Known Drug/Environmental Allergies:______
(please indicate no known allergies if applicable)
Known Food Allergies:______
(please indicate no known allergies if applicable)
Please attach doctor’s note and food allergy action plan if your child has one.
[ ] Consent for posting child’s allergy information, including no known allergies (please print)
I, ______, the parent or legal guardian of ______, who is my minor child, hereby authorize the Lil Highlanders Preschool staff to post my child’s food allergu information in order to protect my child from contact with these foods.
Signature
Does your child have any physical limitations, injuries, illnesses, or health issues which would limit his/her participation in the full range of school activities? If so, please describe:______
______
Child Interests
What activities does your child enjoy with siblings? ______
mother______father______
Other children outside your family______
What type of play would you describe as being your child’s favorite?
______
Least favorite?______
What are your child’s favorite snack foods?______
Least favorite?______
Are there any foods you would like your child to try that he or she has been reluctant to try?
______
Has your child ever been in a play group or other school situation away from you?______
What would you like your child to get out of this preschool experience?______
______
What additional information would you like us to know?______
______
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Additional Information Required
The following items must be received before your child can begin preschool:
Current (less than 1 year old) Child Health Appraisal
Field Trip Authorization
Deposit $20 (to be applied toward first month’s tuition)
Contact Information
Lisa Gonzon
Thomas McKean High School
301 McKennan’s Church Road
Wilmington Delaware
302-992-1949
Field Trip Authorization
Lil Highlander Preschool
McKean High School
301 McKennan’s Church Road
Wilmington DE 19808
I hereby consent to have my/our children participate in field trips supervised by the teaching staff, on the grounds of McKean High School. I will be notified through the weekly newsletter of any field trips.
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Child’s Name (please print) ______
Parent’s signature______
Date______