stcroixmontessori.files.wordpress.com file · web view11) does your child have any special needs...

PRIMARY PROGRAM QUESTIONNAIRE

Today’s date: _________

Student’s Name: ___________________________________ Date of birth: __________

Father’s Name: ________________________ Mother’s Name: ____________________

Who does your child live with? Please check any of the following that apply:

□Both parents □Stepparent □Single Parent – Mother □Single Parent – Father

□Additional Home Caregiver, if applicable: □Grandparents □Other .

Siblings: _________________ _________________ _________________M/F Age M/F Age M/F Age

How does your child get along with his/her siblings? ____________________________________________________________________________________________________________________________________________________

GENERAL:1) Who beside yourself is entrusted with the care of your child? ______________________

How many hours per day? _________ Hours per week? __________

2) What is your child’s daily routine?_________________________________________________________________________________________________________________________________________________________________________________________________

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Wake up time _______Bedtime _________Do you have to wake up your child? _______

Does your child nap? _____________ If so, for how long? ___________

3) Is your child toilet trained? □Yes □No □ Almost

4) What responsibilities does she/he have at home? __________________________________________________________________________

5) What kind of activities do you do with your child? ____________________________________________________________________________________________________________________________________________________

6) Is your child Quiet? □Active? □Very Active? □Other? (Please explain): __________________________________________________________________________

7) How does your child eat? □Well? □Picky?What does your child eat? __________________________________________________

__________________________________________________________________________

8) Does your child have any diet restrictions? □Yes □No. If yes, please give details: ____________________________________________________________________________________________________________________________________________________

9) Does your child have any allergies? □Yes □No. If yes, please list: __________________________________________________________________________

10) Were there any birth complications? ___________________________________________________________________________________________________________________

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Major medical treatments? _________________________________________________Prolonged illnesses? _______________________________________________________

11) Does your child have any special needs the school should be aware of and prepared for?____________________________________________________________________________________________________________________________________________________

12) Do you think your child has any problems and/or are there things that worry you about your child?___________________________________________________________________________________________________________________________________________

13) Does your child have any fears in general and/or night fears? __________________________________________________________________________

14) Does your child have temper tantrums? □Yes □No. If yes, how do you handle them? __________________________________________________________________________

15) Does you child engage in fantasy play? □Yes □No. If yes, describe types of play and how much time spent at this activity daily: _________________________________________________________________________________________________________________

16) Does your child watch TV and/or videos? □Yes □NoIf yes, how often: __________Daily _________WeeklyWhat type of shows/videos does your child watch? ______________________________

17) Is your child independent or does she/he like being helped by others? ______________

What things can your child do alone? (e.g. Washing, Dressing, etc.)

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________________________________________________________________________

18) What are your child’s special interests? ____________________________________________________________________________________________________________________________________________________

19) Does your child have any special dislikes? ____________________________________________________________________________________________________________________________________________________

20) Is your child easy to get along with? ____________________________________________________________________________________________________________________________________________________

21) Is your child able to listen and follow directions? ____________________________________________________________________________________________________________________________________________________

Will your child come when called? □Yes □No

22) How do you discipline your child? ____________________________________________________________________________________________________________________________________________________

23) Has your child been separated from you prior to this experience? □Yes □NoPlease list any previous playground, daycare or schooling experiences:

____________________________________________________________________________________________________________________________________________________

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24) What has your child’s experience been with babysitters/childcare workers? ____________________________________________________________________________________________________________________________________________________

25) Is your child involved in any activities outside of the home? (e.g. swimming classes, etc.) ____________________________________________________________________________________________________________________________________________________

26) How does your child get along with other children? ____________________________________________________________________________________________________________________________________________________

27) Do you have any pets? ____________________________________________________

PARENT SECTION:1) What is your understanding of the Montessori method?____________________________________________________________________________________________________________________________________________________

2) What questions do you have about the Montessori Method of Education?____________________________________________________________________________________________________________________________________________________

3) Why do you wish to enroll your child? ____________________________________________________________________________________________________________________________________________________

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4) Do you plan on taking frequent trips during the school year?_______________________

5) We ask our parents to contribute a variety of resources and talent. Please indicate any special interests or talents you might be willing to share with our students:____________________________________________________________________________________________________________________________________________________

6) Would you be willing to help with any of the following?

□Help students plan field trips? □Drive on field trips? □Help with class events?

□Help with office? □Help make class materials? □Help with maintenance?Other _____________________________________________________________________

7) How did you hear about our school? □Newspaper? □Friend? □Website? □Other?

Please make any additional comments or inquiries below:____________________________________________________________________________________________________________________________________________________

Parent Signature: ________________________________ Date: ____________

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stcroixmontessori.files.wordpress.com file · web view11) does your child have any special needs...

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