2501 OXFORD PLACE | CHARLOTTE, NC 28207 | 704.927.1276

Acquaintance Form

with them from the beginning of school. The information provided on this form will be considered confidential. Thank you!Your thoughtful completion of this form will give your child’s teaching sta� knowledge that will help them work more e�ectively

Child’s Name : Allergies:

Family & Home:Mother’s Name: Mother’s Occupation:

Special talents or interests I can share in the classroom:

Father’s Name: Father’s Occupation:

Special talents or interests I can share in the classroom:

Is a language other than English spoken at home? Yes No If yes, which language?

Do both parents live in the home?

Does your family have a religious a�iation?

Yes No If no, please explain?

Yes No If yes, where do you worship?

Please list others living in your home:Name: Relationship to child:

Does your child have a regular nanny or caregiver? Yes No If yes, what is their name?

Please list any family pets and their names:

Has your child recently experienced a major life change such as a birth, death, remarriage or move? If so, how is your child reacting to it?

Regular Routines : Will your child be relying upon a special comfort item such as a blanket or pacifier while at school? Yes No If yes, how does your child refer to this item?

Is your child currently toilet training? Yes No If yes, what is their current toileting routine?

Is your child currently receiving the following services: Speech Therapy Occupational Therapy Physical Therapy Sensory Integration Therapy Other:

Child’s Interests & Fears :What are your child’s favorite books?

What are your child’s favorite songs?

What are your child’s favorite play activities?

Is there anything that your child may be afraid of while at school? Yes No If yes, what?

Additional information you would like to share? Use the back.

Is there anything that your child may be afraid of while at school? Yes No If yes, what?