Date of Birth
Date of Birth
Nickname, or the name you would like us to use at school
With whom does the child live?
Please describe your child's daily routine (note whether they need help in any area)
Describe your child's play activities:
What are your child's favorite games and activities at home?
What are your child's least favorite things to do?
What time does your child go to bed?
Does your child watch TV? If so, what programs or videos and with whom?
At what age did your child begin to speak? Does s/he speak in 2-3 word phrases, or sentences?
If a language other than English is spoken at home, which language(s), and by whom?
Has your child experienced any emotional events such as divorce, or death in the family? Please explain:
How do you discipline your child?
Does your child have any fears?
Do you have any reports from child psychologist evaluation(s) you can share with us?
Describe the general health of your child:
Was your child breastfed, bottle fed, or a combination?
(Please note that this question is optional: Your answer enables us to know whether your child will have a need we will not be able to meet at school.)
Is s/he weaned yet?
If yes, at what age?
Please list childhood diseases/conditions your child has had (chicken pox, chronic ear infections, asthma, allergies etc.)
Is your child taking any medication on a regular basis? If so, please explain:
Please give a brief account of your child’s birth (How long was labor? Which medications were used? What type of delivery was used? What was your child’s birth size? Were there complications?):
If your child was adopted, at what age did s/he join your family?
If you know their prenatal and birth history, please describe:
What words come quickly to mind when you describe your child?
What aspects of your child’s personality lead you to believe that s/he would thrive in a Montessori learning environment?