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Kindergarten Input Form
Kindergarten Input Form
Please complete the form below. Required fields marked with an asterisk *
Student's Full Name
*
Answer Required
Student's Gender
*
Answer Required
Student's Date of Birth
*
Answer Required
Is your student currently enrolled in the St. Anthony Pre-K program?
*
Answer Required
Yes
No
If your child attended Preschool, what was the name of the school? If they haven't, type "n/a"
*
Answer Required
If your child attended Daycare, what was the name of the Day Care? If they didn't, please type "n/a"
*
Answer Required
Contact Name of Preschool Teacher/Daycare provider?
Answer Required
Email
Answer Required
Phone
Number Required
If your student attended Preschool, was it a positive experience>
Answer Required
Yes
No
If your child attended Preschool, what was it like?
Answer Required
Structured
Mostly Social
Please give a short description of the type of work your child was expected to complete
Answer Required
May we have permission to speak with your child's Preschool/Daycare Teacher?
*
Answer Required
Yes
No
4. Here is a list of activities that most incoming kindergartners can do. Please sit down with your child, have them show you what they can do from the list below, and mark the results! Please note: Children mature at different rates; some things that your child can’t do now, he/she may be able to do by fall! Your honest response is most helpful! Having all the skills listed below is not a prerequisite for kindergarten readiness!
*
Answer Required
Yes
No
Unsure
Can put on his/her coat and fasten it without help
Yes
No
Unsure
Can successfully use pencils and crayons
Yes
No
Unsure
Can sing the ABC song correctly
Yes
No
Unsure
Can name the letters of his/her name
Yes
No
Unsure
Can recognize his/her name written with a capital letter at the beginning and lower case letters in the rest
Yes
No
Unsure
Can count to 20
Yes
No
Unsure
Can cut successfully using sissors
Yes
No
Unsure
Can take care of his/her bathroom needs unassisted
Yes
No
Unsure
With regards to numbers and letters
*
Answer Required
All
Most
Some
A few
Can name the letters of the alphabet?
All
Most
Some
A few
Can recognize the numbers 0-10?
All
Most
Some
A few
Do you expect a "separation problem" the first few days?
*
Answer Required
Yes
No
Has your child attended Kindergarten before?
*
Answer Required
Yes
No
If they have attended Kindergarten before, what was the experience like?
Answer Required
Can your child sit and pay attention to a teacher for 10 minutes?
*
Answer Required
Most of the time
Sometimes
Seldom
Does your child enjoy being read to regularly?
*
Answer Required
Yes
Occasionally
Not yet
We don't have a regular reading time
If reading with your child is a regular part of your family routine, what books does he/she enjoy having read?
*
Answer Required
Does your child attend church services and/or a religious education program regularly?
*
Answer Required
Yes
No
If yes, what is the name of the church/religious education program?
Answer Required
Is the church services/religious
Answer Required
Catholic
Non-Cathoic
Has your child been diagnosed with a learning disability?
*
Answer Required
Yes
No
If your child has been diagnosed with a learning disability, please explain.
*
Answer Required
Has your child ever had an IEP (Individual Education Plan)
*
Answer Required
Yes
No
If yes, please explain and send a copy into the school
Answer Required
What languages are spoken at your home? What language does your child hear most often
*
Answer Required
Please list some of your child's interests and things that he/she likes to do.
*
Answer Required
Please let us know of any health concerns you have for your child
Answer Required
Name and relationship of person completing this form
*
Answer Required
Parent Cell Phone Number that can be used the day of screening
*
Answer Required
Confirmation Email
Confirmation Email
*
Email Required
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