Wahiawa Baptist Preschool
Student General Information Form
Student’s Name:______
Class:______Today’s Date______
HEALTH:
- Condition of you child’s general health______
- Has your child had any serious illnesses or birth defects?______
Explain:______
- Does your child have any known or suspected allergies? ______
Reaction?______
Treatment?______
Medication?______
- Does your child have any special needs or problems?______
Fears?______Nailbiting?______Thumbsucking?_____
Other?______
EATING:
- Does your child have a good appetite?______
- Does your child have any food allergies?______
Reaction?______
Treatment?______
Medication?______
Do understand we do not administer any medications, but epi-pen is an exception school will notify you when we will administer shot.
- Does your child have any eating problems?______
- How often does the family eat together?______
- WBP has my consent to post my child’s name on the list, next to the snack menu, of children with food allergies. I understand this list is used only by the staff of WBP. The list is on the door of the food cabinet.
Signature:______Date:______
HABITS:
- What is used to sooth your child to sleep?______
Comfort object? Rubbing back? Etc?______
- How many hours of sleep does your child normally have? At night?______
During the day?______
- Right or left handed?______
- Does your child need help in Dressing?_____Undressing?_____Eating?_____
Toileting?____ Washing hands?_____
5. What term does your child use for: bowel movement?______Urination?______
SOCIAL RELATIONSHIPS:
- During play my child is ()Active ()Boisterous ()Quiet ()Energetic
()Self-initiated ()Dependent on adult direction.
- My child enjoys playmates ()At home (Outside home ()Prefers adult companionship.
- Does child have their own room?_____If not, with whom does child share room with?______
- What are the ages of the children with whom your child plays with?______
- Has your child been cared for by someone other than parents?______
By whom?______
- Please give information on the following:
Favorite play activities______.
Favorite TV programs______.
Favorite books and stories______.
Favorite Family activities:______..
RESPONSIBILITIES:
- What responsibilities is your child assigned?______
- At child’s present age, your child is best characterized as:
( ) one who is dependent on others for help.
( ) one who tries to do for him/her self.
DISCIPLINE:
- Explain your method of discipline______
______.
2. What points are often issues between parent and child?______
______.
EXPECTATIONS:
- What do you expect the preschool too accomplish for your child?______
______.
- Additional comments you may want to share______
______
.
LANGUAGE:
- What language is spoken at home?______
- Family ethnicities______
TRADITIONAL FAMILY CELEBRATIONS: ______.
Name(s), and their relationship to this child, of person allowed to view child’s health record. ______.
Rev. 1/24/2011