KINKORASTATESCHOOL
PREP PARENT QUESTIONNAIRE
Child’s Full Name:Date of Birth:Tell us three things about your child:
What are your expectations for your child at Prep?
Mother’s Name: / Father’s Name:
Mother’s Phone: / Father’s Phone:
Mother’s Address: / Father’s Address:
Where is your child placed in the family?youngest eldest middle
Is your child an only child? no yes
Who are the people your child lives with? Please include all names and ages, including siblings.
Have there been any recent changes in your family e.g. new house/baby/death in the family? noyes
If yes give details:
Do you have custody arrangements that we need to be aware of? no yes - please give details.
How will your child arrive at and leave Prep? car bus walk bike
Who will collect your child from Prep? Mum Dad Relative Child care assistant Older Sibling
Name/s:
PHYSICAL DEVELOPMENT:
Was your child born at full term? yes no If premature, how early?
At what age did your child crawl? / At what age did your child walk?
Has your child had any serious illnesses, operations or accidents? no yes - please give details
Does your child still have a daytime rest/sleep? yes no
Can your child independently toilet themselves? yes no
Comment:
Do you have any concerns about your child’s development? Please give details.
Has your child had their Community Health - 4 year old check-up? yes no.
Please give details if your child has problems with:
Eyesight yes no / Hearing yes no
Speech yes no / Physical Coordination yes no
Does your child have any allergies? no yes – please give details.
Are any medications required?
Does your child have anaphylaxis? no yesEpipen required with them no yes
*You will need to present a current action plan to the school office at or prior to commencement of school
Does your child have asthma? no yes
Do you have a current Asthma medical plan? no yes
*You will need to present a current plan to the school office at or prior to commencement of school
LANGUAGE DEVELOPMENT:
If you do not speak English, what is the main language spoken at home?
At what age did your child start to talk?
How well does your child listen to and follow instructions?
BEHAVIOURAL DEVELOPMENT:
How would you describe your child?
Is your child independent? YES NO
Follows directions Needs extra direction Talks back
Needs reminders about being safe Likes to get own way Has tantrums
SOCIAL/EMOTIONAL DEVELOPMENT:
How does your child react when you leave them in someone else’s care?
How do you think your child will react to starting Prep?
How do you think your child will cope with five days full time attendance (8:50am – 3:00pm) at Prep?
What opportunities has your child had to socialize with other children their own age?
Day Care Family Day Care Kindergarten Playgroup Other
Which one? Name: ______
Does your child like to play alone or with others?
How does your child react to change, new challenges, frustration and failure?
Do you have any concerns about your child’s social/emotional development? Give details:
Who are some of your child’s friends attending Prep at Kin Kora State School in 2016? List Names
HOME ACTIVITIES:
At the moment, what does your child like to do and play/play with - favourite toys, games, books, DVD’s, TV programs?
How regularly does your child…?
Watch TV ______
Read books ______
Participate in physical activity outside ______
Do puzzles and card/board games______/ Use a computer/Ipad/Device______
Draw/Colour in ______
Play with other children ______
Do writing ______
CULTURAL CONSIDERATIONS:
Assembly/Parade ______Food ______
Celebrations ______Clothing ______
Sporting Activities ______
Give details:
SPECIALIST SERVICES: Has your child been seen by any of the following?
Speech & Language Pathologist? yes no Report yes no Current Program yes no
Occupational Therapist? yes no Report yes no Current Program yes no
Physiotherapist? yes no Report yes no Current Program yes no
Paediatrician? yes noLetter/Report yes no
Psychologist? yes noLetter/Report yes no Current Program yes no
Optometrist? yes no
Audiologist? yes no Report yes no Hearing issues?
Other Specialist? no yes Details:
Does your child have a diagnosis? yes no Give details:
Support Required:
Please give details and copies of any reports to school office.
I/We would like to make an appointment to discuss my child’s needs starting Prep yes no
Thank you for taking the time to fill out this questionnaire, it will assist us in knowing your child better
and used to assist staff in making your child’s transition to school as smooth as possible.
Please return to the school office with your enrolment form as soon as possible.
All information will be kept strictly confidential.
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