Chesterton United Methodist
Preschool Enrollment Form
2012-2013
Child's Name:
(Last) (First) (Middle)
Phone Number:
Address:
(Street) (City) (State) (Zip)
Birthdate:
Place of Birth:
Religious Background:
Email:
Mother's/Guardian Name:
Address:
Occupation:
Status:
Father's/Guardian Name:
Address:
Occupation:
Brothers and Sisters - Names and Birthdates:
I would like for my child to attend:
T-Shirt Size:
Parent Questionnaire
Please complete this survey.
This information will help us to become better acquainted with your child.
We would like to thank you in advance for providing this useful information.
1. By what name do you call your child?
2. Does your child have any medical issues,
i.e. disabilities, allergies, that we should
be aware of? If so, please explain:
3. What terminology does your child use
regarding the use of the bathroom?
4. If your child has attended preschool
before was the experience enjoyable?
5. Does your child have tantrums?
6. If your child has unusual fears, what are they?
7. Does your child use the following at home?
Crayons
Scissors
Pencil
Chalk
Markers
8. What do you see as your child's strengths?
9. Is there any area in which you anticipate
difficulty for your child? (i.e. sharing,
following directions, etc.)
10. What goals do you have for your child?
11. What other information would you like
us to know about your child?
May we put your child's picture on our website?
3-Day Morning Class
is Full!
Students can be placed on a wating list.
