Kindergarten Pupil Survey

(To be completed by the student’s parent/guardian prior to or during registration.)

New Student Orientation Kindergarten Student Inventory

Child’s Name:______Nickname:______Date: ______Parent(s)/Guardian(s) Name(s) ______Welcome! We look forward to working with you to make this a successful year and we would like to get to know more about YOUR child through YOUR eyes. Thank you for taking the time to answer the questions below. Circle the appropriate answer 1. Can your child voice clearly his/her name? YES NO 2. Can your child identify colors: YES NO 3. Can your child speak in sentences? YES NO 4. Can your child recognize the number of objects in a group? (Ex. 5 pencils, 3 marbles) YES NO 5. Can your child count to ten accurately? YES NO 6. Does you child play well with other children? YES NO 7. Does your child accept criticism well? YES NO

8. What kinds of materials has you child played with? (Circle all that apply) Crayons Clay Paints Scissors Puzzles Other:______

9. How often do you read to your child?

10. What frustrates your child most easily?

11. Does your child do the following? Button clothes, snap snaps, zipper clothes? YES NO Put on boots? YES NO Tie shoelaces? YES NO

12. What kindergarten experiences do you feel your child would benefit from the most?

13. Your child is (circle one): Left handed Right handed

14. Please indicate if your child has fears which we should know about (ex. Fear of dogs):

15. Please indicate if your child has any serious health limitations (heart condition, epilepsy, allergies, etc):

16. Are there any specific things that trigger behavior concerns for the child? (circle any that apply) Moving into the child’s personal space 1 Touching the child Talking to the child in a specific way Loud noises (like a fire drill) Getting teased Other: ______

17. What helps to deescalate your child? (circle any that apply) Five minute break Drink of water Walk in the hallway Draw a picture Go to a quiet room/space A hug from a teacher Get a snack Other: ______

18. Has your child attended (Please circle): Nursery School Sunday School Preschool

19. Please provide the name of the school(s) above:

Answer below ONLY if your child has attended Kindergarten: 20. Has your child attended Kindergarten? (Please circle) Yes No If yes: Full Day KN or ½ Day KN 21. Name of Kindergarten: ______22. Reason for Move:______