Temple Sinai Community Preschool
Twinkle Tots (Age 10 to 24 months)
Kiddie Ko-op (Age 18 months by start of school)
Nursery (Age 3 by December 31)
This information will be kept confidential. It is only to aid our staff in understanding and addressing your child’s special needs.
Parent 1 first name
Parent 1 last name
Parent 2 first name
Parent 2 last name
Siblings (living with the child or outside the home):
Sibling 1 name
Sibling 1 age
Sibling 2 name
Sibling 2 age
Sibling 3 name
Sibling 3 age
Sibling 4 name
Sibling 4 age
Changes in Family Network
Are the child's parents separated?
For how long?
What are the current custody/access arrangements?
Your Child's Special Needs
Language(s) spoken by child/spoken in the home
Is your child toilet trained?
Has your child had any previous experience with drop-off programs?
How did your child adjust?
What do you hope this year's experience will do for your child?
Is your child having difficulty adjusting with anything specific (e.g., death/illness in the family, new baby, etc.)?
Are there any other details that you feel can assist the staff in providing special care for your child?
What does your child enjoy playing with? Please share any interests.
Name of parent/guardian (used as signature)