Student Name
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First Name
Last Name
Parent/Caregiver Name(s)
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Email Address
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What name/nickname does your child go by?
Was there anything significant about pregnancy, labor and/or delivery? Please share any pertinent details that would be helpful for us to know (i.e. born premature at 30 weeks, low birth weight, or other)
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Prior to this year, has your child been regularly to a babysitter, daycare, or preschool, without you? Where and when?
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Does your child have any fears we should know about, such as fear of dogs, loud noises, insects, storms?
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Please tell us a bit about your child’s eating habits, including: comfort in trying new foods, staying at the table to eat, ease in using utensils and drinking for a non-lidded cup, and using a napkin.
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Is your child using the toilet? If not, how far has training progressed? (We expect the child to have an understanding of how the toilet works, and how to pull their pants up/down, and comfortable in cloth underwear. Due to Virginia Social Service guidelines, diapers or Pull-Ups are not permitted in the classrooms)
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Does your child need help in the bathroom with buttons, zippers, tucking in their shirt, wiping, etc.?
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Does your child use a pacifier or other self-soothing method as they prepare for rest time? (we do not utilize pacifiers at school)
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Do you suspect your child has any allergies (food, drugs, bee stings, animals, etc.)? If they have been stung before, what was their reaction?
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Who will be bringing your child to school? How does your child deal with transition away from this person? How does this person deal with transition away from your child? Do you anticipate any issues with separation?
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Do you anticipate any particularly difficult times for your child at school, for example saying good-bye in the morning or relaxing at rest time?
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Is there anything else you would like us to know?
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