2023-2024 Social History Child's Full Name* First Middle Last Child's Preferred Name Parent Email (for form confirmation):* Child's Date of Birth Child's Current AgeDoes your child have siblings who are alumni and/or currently attending WPELC? If so, please name them.Who does this child live with?* Others living in the homeex. Grandparent, Au Pair, etc.Other significant adultsex: Nanny, Day Care, Relatives, etc.Help the Teacher Learn About Your ChildHas your child had any previous formal group experience such as childcare, play group, etc.?* Yes No Please explain this previous group experience.* What is your child’s comfort level with integrating into a new group?*Detail any social or emotional experiences you feel the teacher needs to be aware of, such as a death in the family, divorce, accident or illness, hospitalization, move, adoption, separation from parents/guardians for extended periods of time, etc.:*Does your child have any medical conditions that your teachers should be aware of? (i.e. allergies, dietary restrictions, wears glasses/hearing aids, etc.)* Does your child have any delays/challenges with any of the following (check all that apply):* Hearing Vision Speech Mobility None Please provide additional information to help WPELC learn about these delays/challenges.*Does your child have any developmental delays, or are there any developmental areas in which your child needs special help or encouragement?*Does your child have any behaviors you are currently working on (ex. thumb sucking, biting, hitting, anger management, etc.)?*What discipline do you feel works best for your child?*What are some of your family’s favorite activities?*What are some of your child’s current interests?*What are some of your child’s fears?*How does your child separate from you?*What else would you like the teacher to know about your child?*Help Us Learn About YouWhat values are important in your family*ex. kindness, curiosity, growth mindset, etc. When allowed, are there specific activities you would be interested in sharing with the children in the classroom?*ex. woodworking, painting, weaving, baking, playing musical instruments, dancing, gardening, etc.Does your family have any customs or traditions that you would like to share with the class?*ex. Hanukkah, Diwali, Dia de los Muertos, Ramadan, Lunar New Year, etc.What do you hope this preschool experience will provide for your child?*
