Miami Elementary
2021-2022 Kindergarten Student Information
Welcome to Camp Kindergarten!
Please complete the following information for each child you will be registering. This form will be used during the placement process to help staff create balanced classrooms.
Child's Name
First Name
Last Name
Child's Date of Birth (mm/dd/yyyy)
Gender
Female
Male
Parent/Guardian Name #1
First Name
Last Name
Parent/Guardian Phone Number #1
-
Area Code
Phone Number
Parent/Guardian Name #2
First Name
Last Name
Parent/Guardian Phone Number #2
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did your child attend preschool?
Yes
No
If you answered "yes" above, how many days a week did your child attend preschool?
1-2 days
3-4 days
5 days
Name of preschool attended:
Please list siblings and ages, or write N/A:
What do you view as your child's greatest strengths?
What does your child like to do in his/her free time?
Does your child have access to a computer/laptop/tablet at home?
Yes
No
Tell us a little about your child's personality or preferences: (example...outgoing, shy, prefers to... does well with...)
Are there any social, emotional, physical or academic issues that may be an area of concern?
What goals and/or concerns do you have for your child in his/her Kindergarten year?
Does your child have any medical concerns we should know about? (Allergies, vision, hearing, diabetes, heart conditions, syndromes, asthma, seizures, dietary restrictions, dental appliances, motor restrictions, other)
Would you be interested in your child attending SACC (School Aged Child Care)?
Is your child currently receiving special education services? If yes, please provide additional information.
Thank you so much for taking the time to complete our survey!
Miami Elementary Kindergarten Team
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