Kindergarten Questionnaire

Dear Parents: You are invited to complete the following questionnaire and return it with your registration package. This information will provide the teacher with important information and will assist in supporting your child as he/she makes the transition to school.

Thank you for taking the time to complete this information.

General Information

Child’s Name: / Date of Birth:
Name of Parent(s)/Guardian(s):
1. ______
2. ______/ Place of Birth:
Date of Arrival in Canada (if applicable):
Are both parents/guardians residing with the child?
 Yes
 No If no, please indicate where the child resides during the school week. / Child’s First Language is
What language(s) is/are spoken at home? ______
Arrival at School:
My child will be accompanied to school by:
 Parent  Caregiver  Sibling  Other ______
Departure from School:
My child will be picked up by:
 Parent  Caregiver  Sibling  Other ______

Physical and Health Information

Health concerns may affect a child’s learning, behaviour or physical activity. Please assist us by completing the following information.

Date of most recent Hearing Assessment: ______

Date of most recent Vision Assessment: ______

Has your child experienced any of the following in the past?

yes / no / If yes, please comment:
Birth Complications
Ear Infections
Hearing Loss
Tubes in ears
Vision Problems
Asthma
Food Allergies
Sleeping Problems
Headaches
Nose Bleeds
Skin Irritations/eczema
Epilepsy
Surgery
Notable Accidents/Injuries
Stomach Problems
Bowel, Bladder problems
Other

At approximately what age did your child learn to:

Walk ______Talk ______Become Toilet Trained ______

Has your child received support from any specific agency in the past

(e.g., KidsAbility, Kidslink)? If yes, please describe:

Please describe any additional health information that might impact learning at school.

Additional Information

Pre-School Experiences: Please indicate the major pre-school experiences your child has had. Please indicate the duration. (e.g., 3 months, 2 years,etc.)

Child Care Centre ______Nursery School ______

Nanny ______Home Care ______

Play Group ______Other ______

Limited pre-school experience ______

How does your child feel about starting school? (e.g., nervous, excited…)

How would you describe your child’s personality? (e.g., shy, outgoing…)

Describe how your child adjusts to new experiences?

What activities do you and your child like to do together?

Indicate whether your child is independent with (please check):

 Dressing Snaps Zippers  Laces

 Buttons Putting on/take off shoes

 Opening containers for snacks  Opening wrappers and packages

Describe any other additional information you feel would assist the teacher in getting to know your child and helping support him/her during his/her Kindergarten day.

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