Please complete this form below with your child, so that I can have some background information about my new student! I am very excited to have a happy and productive year!
Optional fields are marked with a
red asterisk *
Examples and important information indicated in
Blue
Student Information
First Name
Middle Initial
*
(Do not include a period)
Last Name
Birthday
(Example: 02/05/1980)
Gender
Choose one
Male
Female
Home Phone
(Example 123-456-7890)
Emergency Phone
(same way as above)
Please list any other children and their ages
What time and day is best time to have a conference if needed?
AM
(8:30)
PM
(3:30)
Monday
Tuesday
Wednesday
Thursday
Friday
Child's Interests
Favorite Colors
(Check all that apply)
Red
Blue
Green
Orange
Yellow
Gray
White
Teal
Purple
Black
Pink
Brown
Do you have any pets?
(Check all that apply)
Cat
Dog
Bird
Fish
Hamster
Snake
Ferret
Other
What do you like to do for fun?
What do you want to learn in First Grade?
Strengths and Weakness
Briefly tell me about your child's strengths.
(Example: good reader, quick to learn new things, etc.)
Briefly tell me about any of your child's weak areas or struggles.
(Example: hard time grasping new concepts, hard time working with others, etc.)
Site designed and maintained by:
J. Koehler
Last Updated:
December 20, 2006
