Questionnaire for Parent Step 1 of 8 12% Parent QuestionnaireStudent Name First Name Last Name NicknameDate of Birth Date Format: MM slash DD slash YYYY AgeGenderMaleFemaleAddress Street Address City State / Province / Region ZIP / Postal Code Parent/Guardian #1 NameParent/Guardian #1 OccupationParent/Guardian #2 NameParent/Guardian #2 OccupationProgram*Toddler ProgramPrimary ProgramElementary Program General Health HistoryDescribe your child’s general health conditionIs there any pertinent information concerning your child’s pre-natal, birth and first years that you would like to share?Has your child had any severe injuries or illnesses?YesNoPlease explainHas your child been hospitalized?YesNoPlease explain & DurationDoes your child have any physical restrictions?YesNoIf yes, describe brieflyWhen was your child’s last visit to a doctor? Why?Does your child have any allergies?YesNoPlease explainIs your child on any routine medication?YesNoPlease explain BehaviorDescribe your child’s general temperamentCheck the words that best describe your child: happy quiet industrious even-tempered sensitive dependent withdrawn aggressive friendly stubborn agile good-natured impulsive independent fearful industrious moody attentive shy playful Does your child have any special fears?YesNoIf yes, please describeWhat are your child’s favorite activities?Does he/she have any special experiences or interests?YesNoIf yes, please describeDoes your child watch television and/or videos, play computer or video games?YesNoHow long each day?What is the general mode of discipline for your child at home?Does your child accept correction easily? Please indicate if your child has had to cope with any of the following:Recent move?Separation from a loved one?Who?How? (death, estrangement, divorce, other) Daily RoutineWhat time does your child get up: in the morning?Go to bed at night?Does your child sleep through the night?YesNoDescribe the ease/difficulty of these times for your childDoes your child nap during the day?YesNoWhen & How long?What does your child sleep in? Social RelationshipsDoes your child relate easily to strangers?What does your child enjoy doing with their family?What does your child enjoy doing with Mom?What does your child enjoy doing with Dad?Does your child play well alone?YesNoDoes your child play with children of his/her own age?YesNoDoes your child play well with older children?YesNoDoes your child play well with siblings?YesNoHas your child had a group play experience?YesNoPlease explainDoes your child participate in lessons, sports teams, other group activities out of school?YesNoPlease explainName of most recent school that your child has been inLength of time in program?May we contact them?Name of TeacherPhone #Why do you want to send your child to a Montessori school?What are your wishes, desires, etc. for your child now and in the future?Additional Comments Toileting It is our policy that all children who enter the Primary program be toilet-trained. Please be comforted by the fact that we expect that children will have accidents from time to time. We consider a child to be “toilet-trained” if s(he) can indicate his/her bathroom needs, is comfortable and accepting of school toileting facilities and can complete the process without a need for an adult (for the most Part). For your child’s well-being, please try not to pressure him/her into training in an effort to make the enrollment deadline because we feel it caused undue stress and anxiety and is rarely successful. A comfortable guideline is to give your child at least a month of successful toileting before starting school. How does your child indicate his/her bathroom needs?How long has your child been toilet-trained?Is your child fearful of new toileting situations?YesNoPlease explainTell us about your family's religious spiritual beliefs Mission Statement The mission of the St. Paul’s Episcopal Montessori School is to provide an outstanding Montessori-based education, in the Episcopal tradition, to culturally and economically diverse groups of children, nurturing the child’s mind, body and spirit.