Questionnaire for Parents/Caregivers of Primary School Children

A child learns best when their education is a partnership between home and school.As parents or caregivers you are the most knowledgeable about your child. A great deal of learning and development has already occurred in your child’s life before they started school and we value your input as we build an understanding of your child and address his/her learning needs and strengths. Often there are significant factors that impact on learning and early identification is always beneficial for the learner.

The Birth and Well-Being / Yes / No / Comment – if relevant
Was the pregnancy normal?
Was your child born prematurely?
Was oxygen required?
Has your child had any significant health concerns during their first 5 years?
Has your child had significant ear infections?
Family History / Yes / No / Comment – if relevant
As parents was your schooling a positive experience?
Did either parent have difficulties with reading, spelling or writing?
Have any other siblings or relatives had challenges with learning?

Pre School Development

Speech and Language Development / Yes / No / Comment – if relevant
Was your child later or earlier than most children to talk?
Has your child had difficulty pronouncing words (i.e., busgetti for spaghetti, mawn lower or lawn mower) ?
Has your child been able to remember and respond to nursery rhymes, songs and chants?
Has your child have any difficulty with rhyming?
Has your child been slow to add new vocabulary words?
Has your child had any trouble learning numbers, days of the week, colors, shapes, and how to spell and write his or her name?
Gross Motor Skills / Yes / No / Comment – if relevant
Did your child crawl?
How old were they when they learned to walk? / Age:
Did your child have any difficulties climbing down stairs?
Did your child frequently fall over or bump in to objects?
Has your child had any difficulties learning to ride a bike?
Has your child been able to join in and play games such as musical chairs or Simon Says?
Has your child had any difficulties learning to skip, hop, jump?
Fine Motor Skills- early years of primary / Yes / No / Comment – if relevant
How old was your child when they used the same hand consistently?
Has your child had a tendency to spill or knock things over?
Does your child find it hard to sit still?
Can your child dress themselves?
Can your child write their own name?
Has your child shown interest in drawing, colouring-in or dot-to-dot type activities?
Can your child complete simple/complex puzzles?
Does your child enjoy spending time on construction type toys e.g. lego?
Has your child had any difficulties cutting with scissors?
Auditory Memory / Yes / No / Comment – if relevant
Does your child confuse similar-sounding words?
Does your child forget to do what they are asked to do?
Are they able to remember and follow simple instructions?
Are they able to remember the names of people or songs?
Visual Memory- early years of primary / Yes / No / Comment – if relevant
How old was your child when they recognized their own name?
Can your child play simple games involving matching pair of pictures?
Can your child sort objects according to sizes or shapes?
Can your child thread beads?
Can your child remember where they left an object such as a favourite toy?
Temperament / Yes / No / Comment – if relevant
Can your child settle to a task and stay occupied for a period of time?
Do they get on well with siblings or other children?
Can they sit and listen to a story being read to them?
Are they able to remember and follow a story when it is read to them?
List activities that your child enjoys doing:
List activities that your child is good at:
Include any further information or comments that you think may be useful e.g. significant events in the family, hospitalisation, accidents, shifting house, parental separation.
Would you like to have the opportunity to discuss any of these details further if there are concerns about your child’s development at this stage?

Please note that any information that you supply will be treated as confidential and used to help build understanding of your child’s learning needs and preferences. You are welcome to contact the school at any time regarding the progress and development of your child.

Child name: / Date of Birth:
Parent Name: / Parent Signature: