Kindergarten Information Sheet

Childs Name: ____________________ Prefers to be called: ____________________

Childs Address: ________________________________ Birthdate: _________________
Important medical information/allergies: _____________________________________
_____________________________________________________________________________

Parent/Guardian #1: ________________________________________________________

(relationship and last name, if different from childs)

Home phone: _______________________________________________________________

Work phone: ________________________ Place of employment: _________________
Cell phone: _________________________________________________________________
Email address: ______________________________________________________________
Please circle the best way to reach you to communicate with you about your child

Parent/Guardian #2: ________________________________________________________

(relationship and last name, if different from childs)

Home phone: _______________________________________________________________

Work phone: ________________________ Place of employment: _________________
Cell phone: _________________________________________________________________
Email address: ______________________________________________________________
Please circle the best way to reach you to communicate with you about your child
Child lives with: (circle all that apply)
aunt

uncle

mother

father

other: ______________________

grandmother

grandfather

other: _________________________

Over

Childs siblings and grade levels/ages:

Name

Age

Grade/School

______________________

_______

_________________

______________________

_______

_________________

______________________

_______

_________________

______________________

_______

_________________

Tell me about your child

My childs interests and/or hobbies include ___________________________________
_____________________________________________________________________
Something my child is very successful at ____________________________________
_____________________________________________________________________
Something my child has trouble with _______________________________________
_____________________________________________________________________
My childs special qualities include _________________________________________
_____________________________________________________________________
My child approaches learning (check all that apply)
___ with excitement
___ with confidence

___ with curiosity

___ with anxiety

___ with reluctance

___ without interest

Other comments youd like to share about your child and his/her learning:
_____________________________________________________________________
_____________________________________________________________________
Goals for my child in kindergarten: _________________________________________
_____________________________________________________________________
Thank you for taking the time to fill this out. It will help me get a jump start on
getting to know your child.