* Required

Child's Namerequired

Date of Birth (MM/DD/YYYY)required

It is helpful for us to have the following information so we can make your child’s transition to a new classroom as smooth as possible. All answers will be considered confidential and you may wish to discuss some things with the teacher face-to-face early in the year.

As the year progresses, please also keep us informed of changes at home such as an impending birth of a sibling, the death of a grandparent, the arrival of a pet, etc. so we can help bridge the gap between home and school.

Please complete all applicable sections. For required fields, enter n/a if they do not pertain to you.

Family

Parent 1 Namerequired

Occupationrequired

Place of Employmentrequired

Phone Numberrequired

Where you can be reached at work

Work Address required

City required

zip coderequired

Parent 2 Namerequired

Occupationrequired

Place of Employmentrequired

Phone Numberrequired

Where you can be reached at work

Work Address required

City required

zip coderequired

Parents arerequired

With whom does your child live?required

Names of other adults in your home and their relationship to your child [e.g. Nonna (grandmother). Indicate if this person is responsible for some or all of the child care

What is the primary language spoken at home?required

Are there any other languages spoken in your home?required

Please list any daycare or pre-school previously attended by your child:

Please list the name of any other program or school, and class level, that your child is expected to be attend concurrently during this school year:required

Please list your child’s siblings, their ages, and if they are in school, the school they attend

How do the siblings generally relate to one another?

What are your child's favorite activities and toys?required

What are the favorite family activities?required

Approximately what time does your child:

Wake up?required

Nap?required

Go to bed?required

Does your child maintain a consistent bedtime/sleep schedule?

Does your child go to bed?*

Easily With Difficulty

With whom does your child eat dinner?required

Describe your child's eating habitsrequired

Does your child have any allergies or dietary restrictions?*

Yes No

If so, please describerequired

Your Child's Development

Is this your child's first year at CDS? *

Yes No

Began walking at age:required

Spoke first word at age:required

Began feeding self at age:required

Spoke first sentence at age:required

Began toileting self at age:required

Began sleeping in own bed at age:required

Describe your child's:

SOCIAL DEVELOPMENT: (getting along with others, making friends)required

EMOTIONAL DEVELOPMENT: (general disposition; temperament; ability to cope with frustration)required

PHYSICAL DEVELOPMENT: (coordination; strength; endurance)required

INTELLECTUAL DEVELOPMENT: (problem-solving abilities; concept understanding)required

What especially interests your child?required

Please describe anything about your child’s development, or your relationship with your child, which concerns you.

Has your child ever had any screenings, evaluations or therapies?*

Yes No

If so, please describerequired

What do you see as your child’s strengths?required

Discipline

What values or character traits do you nurture at home?required

What responsibilities do you expect your child to assume at home?required

What limits or restrictions do you place on your child?required

What behaviors do you find difficult in your child? How do you deal with them?required

Has your child ever run away from you? (e.g. from your house, a shopping center, park, other place.)required

Your Child at Country Day School

Has your child been in school or another peer group? Please describe.required

What expectations do you have for your child this year?required

What are some holidays or traditions your family celebrates?

Are there particular areas in which your child needs special encouragement and support?required

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :