Child’s Name _________________________________

Parent/Guardian  _______________________________

Address ______________________________________

Phone Number _________________________________

Parent/Guardian Work Number ____________________

Child’s Birthday ________________________________

Please tell me 1-3 things your child is interested in:

1.

2.

3.


Does your child enjoy reading (looking at) books at home? ________

Does your child enjoy being read to?__________

Does your child enjoy writing and drawing pictures at home?  _______

Is there anything you would like me to know about your child?









(Please use the back of this form if you need additional space.)

Thank you! I look forward to getting to know you and your child this year!