Getting to Know My Child: A Guide for My Child's Kindergarten Teacher

Transitioning to Kindergarten

Child's Name ________________________________________________________________________________________

Basic Information

Name(s) of Person(s) completing this form: _________________________________________________________________

Date: _______________________________________________________________________________________________

School: _____________________________________________________________________________________________

Child likes to be called: _________________________________________________________________________________

Child's date of birth: ____________________________________________________________________________________

Mother's name: _______________________________________________________________________________________

Father's name: _______________________________________________________________________________________

Other adult(s) living in the home: __________________________________________________________________________

Address: ____________________________________________________________________________________________

Phone(s): ___________________________________________________________________________________________

Best time to reach us: __________________________________________________________________________________

About My Child

My child's favorite things:

favorite color _________________________________________________________________________________________

favorite food __________________________________________________________________________________________

favorite book _________________________________________________________________________________________

favorite toy ___________________________________________________________________________________________

favorite expression ____________________________________________________________________________________

other favorites: ________________________________________________________________________________________

My child is good at:

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My child likes to (check all that apply):

Listen to stories _________________

Draw and color __________________

Play alone ______________________

Play with other children ____________

Play outside ____________________

Play quiet games inside ___________

Go to a friend's house _____________

My child doesn't like to:

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I'd like you to know this about my child:

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My child learns best by:

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About My Child's Early Learning Experiences at Age 4:

If your child is not enrolled in any program, check here______

My child has been enrolled in (name of preschool or program) _____________________________ from (date) _____________

to (date) ___________________. 

This is a (check one):

Child Care Center ________________________________

Family Child Care Home ___________________________

Parents as Teachers program _______________________

Other __________________________________________

For more information about this program, contact:

Name: ______________________________________________________________________________________________

Phone: ______________________________________________________________________________________________

About Our Family:

We speak the following languages in our home: ______________________________________________________________

Most of the time, I speak (write in language) ________________________________________________________ to my child.

Most of the time, my child speaks (write in language) ____________________________________________________ to me.

Some things I'd like you to know about my family (culture, activities that the family enjoys doing together, other):

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There are ____________ children in the home. Their ages are:

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The best times for me to come to the school are:

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My family would like to share the following skills or activities with our child's class or school:

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Screenings and Special Services:

My child had a hearing screening on (date) _____________ at (location) _____________. 

Results:

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My child had a vision screening on (date) _____________ at (location) _____________. 

Results:

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My child had other screenings: Speech: date___________location_______

Results:

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Other (please describe):
My child receives these supports and special services: If your child does not receive any special services, check here: ___

Type of Service received last year receives this year amount of time per week should receive in kindergarten Occupational Therapy (OT)
Physical Therapy (PT)
Speech and Language (S/L)
Social Worker

Other (Please describe):

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I would like you to observe my child because I am concerned about the following:

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Thank you for getting to know my child!

We want to work with you to ensure a successful kindergarten year!

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Signature                                                                                                                                                                                        Date

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Signature                                                                                                                                                                                        Date