Parent Questionnaire

TISA KINDERGARTEN PARENT QUESTIONNAIRE 2016/17

Child’s FIRST Name _____________   LAST Name______________  Nickname: ____________

Date of Birth ________________________  Place of birth _______________________________

Parents’ Names___________________________________    ______________________________

The information I am requesting below will help me understand your child better. It will be kept confidential.

Please share what led you to enroll your child at TISA.

What’s your child’s school experience so far?

schedule: 5 / 4  / 3 / 2 / 1 / 0 days a week    full day/half day         regular / occasional attendance  

Play-based program        academic program

How do you and your child feel about entering kindergarten?

What does your child most enjoy doing?

Favorite game

Favorite book

Place to visit

Best friend/s

Sport/s

Family pastimes

What are some activities that your child can most sustain focus with?

Are there any recent life events/changes that have occurred in your family?  Please check any that apply:

Move  _____ New Sibling/Family member  _____ Divorce/Separation _____  Illness_________ Trauma______ Accident/injury/surgery___________     Death_______________  Other:

Does your child have brothers of sisters? 

NAME: _____________________natural / adopted / step   Age:     _______

              ________________________  natural / adopted / step                   _______                     

              ________________________  natural / adopted / step                   _______                     

             

Is your child a member of a ___ two parent family?    ___ single parent family?   ___ step or remarried family?

Parents live in same/different households. (please circle)

What language/s do you speak in your home? _____What language is spoken where you were born?_______

What is your child’s reaction to stress/conflict?  Please check any that apply.

____Crying     ____Headache     ____Stomach Ache      ___ Biting/kicking/hitting ___Withdrawing      ___Acting out    ____throwing    ____spitting   Other? ______________________  __________________

Does your child tend to use his/her right or left hand?                     Right or left foot?

Does your child rest/nap during the day?

What is your child’s usual bedtime?

Do you know of any friends your child might have in his kindergarten class at TISA or in other grades?

Does your child have any illness, allergies or follow a special diet?  Frequent nose bleeds? Blood sugar to watch? Gets sunburnt easily? Wears glasses?

What exposure does your child have to media (TV, computer games, e-books, tablet, cell phone)?

none           couple times a week                1   2   3 hours a day            

Please share your comments on the use of media at home and at school.

How long will it take for your child to get to school in the mornings?

Your child's health history (please circle all that apply).

Premature birth/birth injury          Head injury/concussion        broken bone        stitches         hospitalization         surgery       toothache           nosebleeds            fainting         night terrors

Any fears your child might have?

Is there anything else you feel we need to know about?

Please be advised that your child may be photographed or video-taped at various school-sponsored events.  I ______ give permission       _____do not give permission to have my child appear in a photograph or video on TISA's blogs, TISA's web site, TISA's Facebook page or other public forum (such as the Taos News).

You, as parents are the backbone of our class community. We welcome your participation and hope we can find meaningful ways for you to be part of our learning expeditions this year.

Thank you for taking the time to complete this questionnaire. I look forward to working together with you and your child.

Jutka