54-month Assessment

  • PARENT QUESTIONNAIRE

  • Dear Parents,

    Please help us get to know your child by filling out this form. All the information will be confidential. We will use what you tell us as we begin to get to know your child and plan ways to meet his/her needs and to help him/her develop. Please return it to school as soon as possible.

    Thanks so much!

  • Date Format: MM slash DD slash YYYY
  • It is our goal to encourage a sense of belongingness, promote an appreciation of others and enrich children’s experiences by integrating into our curriculum activities and information that reflect our individual children’s background.  One way we can do this is by learning about each child’s family background, celebrated holidays, and traditions. Please take a few minutes to share with us your special family days or activities and how they are carried out in your home.

  • Date Format: MM slash DD slash YYYY
  • Person filling out Questionnaire

  • Program Information

  • Important Points to Remember:

    • Try each activity with your child before marking a response.
    • Make completing this questionnaire a game that is fun for you and your child.
    • Make sure your child is not tired or hungry.
    • Please return this questionnaire by ________________________
    • Gross Motors

    • Fine Motor

    • Problem Solving

    • Personal Social

Voice Your Opinion

Your feedback is valuable to us and 100% Anonymous. If there is a program or class you would like to see added, let us know. A concern or changes you would like made, let us know. Anything, let us know.

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    Voice Your Opinion