CAMP CURIOSITY ACADEMY
Curiosity Academy Student Survey
Child's Name
Child's Birthdate
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Select the program your child is enrolled.
Preschool (Ages 1-4)
Kindergarten Prep (Ages 4-5)
Kindergarten
What are your child's meal habits? Please include any food allergies or intolerances.
What are your child's sleep habits? (Only for Preschool students.)
Bathroom Training
Fully, independently training
Almost trained, still a few accidents or needs adult help
Introduced training at home after showing interest
No interest or progress toward training yet
Is your child wearing:
Underwear 24/7 & staying dry consistently
Underwear with diapers for sleep
Underwear & diapers both day & night
Only diapers
If not fully independently bathroom trained, does your child have a typical diapering schedule or needs?
Has your child experienced care outside the home? In a center? In a home? If so, please briefly describe your experience.
How would you describe your child's personality?
How would you describe your child's learning style?
What motivates your child?
Does your child have any favorite activities or interests?
How does your child successfully communicate their needs and emotions to adults and peers?
Does your child have any apprehensions (i.e. being away from parent new people new places animals)?
What are your goals for your child's enrollment in our program?
Parent Signature
*
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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