This information allows us to better understand your child’s developmental and educational needs. Thank you for helping us get to know your child a little better.
Basic Information
Name
*
First Name
Last Name
Primary Language of Child
*
Primary Language of Parents/Guardians
*
Birth and Infancy
Is there any information about your child’s birth/infancy which you think would help the teacher more fully understand your child, for example, birth complications, illnesses, adoption?
*
Did your child experience any developmental delays that required Early Intervention Services?
*
Eating Habits
Special characteristics or difficulties, including allergies or sensitivities:
*
Eating Speed
Slow
Fast
Favorite Foods
Food Refuses
Toilet Habits
Is your child ever reluctant to use the bathroom?
*
Does your child have accidents?
*
Does your child have any special needs in this area?
*
Sleeping Habits
Does your child become tired or nap?
*
When does your child go to bed?
What time does your child typically wake?
Nightmares
Please Select
Never
Occasionally
Frequently
Bed Wetting
Please Select
Never
Occasionally
Frequently
Uninterrupted sleep
Please Select
Never
Occasionally
Frequently
Child sleeps in
Own room
Shared room with sibling/s
Family bed
Family / Home
Please list household members
Please list all household members, their relationship to the student, and the ages of other children in the house.
*
Does your child have other siblings living in a different home?
*
Yes
No
If yes, please list names and ages
*
Please describe your child’s schedule on a typical day
*
How do you discipline your child?
*
Have there been significant changes in the family (death, illness, divorce/separation, moves, etc.)
*
Briefly describe your attention to family traditions, rituals and celebrations
*
Previous Educational Experiences
Please list any schools your child has previously attended?
*
Has your child received a specialized evaluation, such as educational / psychological, hearing, speech,etc.?
Yes
No
Please describe
*
Does your child currently receive Early Intervention Services?
*
Yes
No
Please describe
*
Social Relationships
How would you describe your child?
*
How is your child in a social setting with peers?
Favorite toys and activities
Fears
Describe the role that media plays in your child’s life
*
Hours of media exposure (TV, computer, video, electronic games, radio) daily
*
How are you hoping a Waldorf school experience will affect your child?
*
Is there anything else you would like us to know about your child?
*
Aurora Waldorf School is committed to making Waldorf education available to every family. The Tuition Adjustment Committee will consider requests for tuition assistance upon the school’s acceptance of your child. Would you like to apply for Tuition Adjustment?
Yes
No
Parent / Guardian 1 Signature
*
Parent / Guardian 2 Signature
Submitter's Email
*
example@example.com
Type a question
Submit
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