Family Questionnaire - Key School
Family Questionnaire - Key School
Family Questionnaire - Key School
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Family</strong> <strong>Questionnaire</strong><br />
Please help us to get to know your child and his or her family. We look forward to forming a<br />
collaborative relationship that will ensure your child reaches his or her fullest potential. Thank you for<br />
sharing this information with us.<br />
Child’s Name _________________________________________________________________<br />
Nickname ____________________________________________________________________<br />
FAMILY STRUCTURE<br />
1. Who lives in your child’s home<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
2. Describe your child’s sibling and extended family relationships.<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
3. Describe your family’s daily schedule<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
4. How does your child help at home<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
5. Do you have any rules in your home<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
FAMILY CULTURE<br />
6. Describe your family’s cultural holidays, celebrations and or practices.<br />
_____________________________________________________________________<br />
_____________________________________________________________________
7. What languages are spoken in your household and with your extended family<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
8. Describe your family’s core values.<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
9. What activities do you enjoy doing together as a family<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
PARENTING<br />
10. How and when are meals served in your family<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
11. Describe your child’s napping/sleeping routine and schedule. Does your child share a<br />
bedroom and with whom<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
12. Is your child completely potty trained, including dry at night If not, what strategies<br />
are you using to work on this We expect each child to be potty trained and quite<br />
independent regarding bathroom routines.<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
13. How does your child react to frustration How does your child relax or soothe him or<br />
herself<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
14. Does your child have any special medical history (e.g., premature birth, surgeries)<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
15. Do you have any special concerns about your child (e.g., anxiety, fears, separation)<br />
_____________________________________________________________________<br />
_____________________________________________________________________
16. Has your child participated in any educational or enrichment activities (e.g., camp,<br />
gymnastics, speech, swimming)<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
17. What kind of activities does your child especially like to do at home<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
18. Do you think your child is right or left-handed<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
19. How do you discipline your child<br />
_____________________________________________________________________<br />
_____________________________________________________________________<br />
20. Is there anything else you think we should know about you or your child<br />
_____________________________________________________________________<br />
_____________________________________________________________________
Change language