1. Child Development and Interest Survey
This survey is designed to provide me with information that will be used to create an authentic learning environment
and curriculum. Please use additional paper if needed. Thank You, ___________________________________
Date________Child's Name (as he/she wants to be called at school) __________________ Birthdate__________
1. Please list all of the names and ages of your child's brothers and sisters, and other family
(including mom and dad) members living in the same household (including pets).
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2. Has your child had any preschool or play group experience? If so, where and what was his/her
experience like?
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3. Has you child acquired any of the following skills? Place check mark by skills mastered.
___Knows address. ___Knows phone number. ___Knows birthday. ___Can tie shoes.
___Recognizes capital letters ___Recognizes lowercase letters. _____ Knows letter sounds.
Recognizes numbers up to ______. Can count up to ______.
___Other (any special skill you would like me to know about) _____________________________
4. What do you feel your child's strengths are?
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5. Describe your child's general temperament/personality.
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6. Is your child afraid of anything? Are there any events or activities that may upset your child?
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7. What are your child's favorite toys, books, and activities?
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©2012 Dee Jammal

2. _______________________________________________________________________________
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8. Does your child speak a foreign language?___________________________________________
9. How do you feel your child learns best? ____________________________________________
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10. How does your child deal with conflict and what form of discipline do you use at home?
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11. List important holidays and/or events you celebrate. Are there any holidays you do not
observe?________________________________________________________________________
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12. What kinds of talents or ideas can you (the parent) share with your child's class?
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13. What are your expectations for your child’s experiences at school?
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14. Is there anything else you would like to tell me about your child?
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3. ©2012 Dee Jammal