| Dear Family,
September is a time to get acquainted. You can help
by filling out the questionnaire below. Questions with an asterisk
(*) are optional. |
| 1. Child's Name: First Name
|
Last Name |
| Does your child go by a nickname? (Example: Chris
instead of Christopher) Yes No |
*Preferred Name
|
| 2. Mother's Name:
First Name
Last Name
|
Father's Name:
First Name
Last Name |
| 3. What are some things your child is interested
in? Please check all that apply: |
|
Reading |
Computers |
|
Outdoor
Activities |
Boys & Girls
Club |
|
Boy Scouts |
Girl Scouts |
|
Television |
Video Games |
| 4. Does your child have access to a computer at
home? |
Yes
No |
| 5. Does your child have access to the internet at
home? |
Yes
No |
| 6. Did you set parental controls on the computer? |
Yes
No |
| 7. Do you monitor your child's use of the
computer? |
Yes
No |
| 8. Have you discussed internet safety with your
children? |
Yes
No |
| 9. How will your child be picked at dismissal?
|
Please specify other: |
| 10. In area below please include any additional
information you would like me to know about your child.
|
|