Personal History Personal History Step 1 of 3 33% Child's Name* First Last Parent's Name* First Last Are both parents living in the household?*YesNoIs either parent deceased?*YesNoAre there any legal facts regarding a divorce, separation, custody, adoption etc. that the school should be made aware of?*Is either parent away from home for long periods of time?*YesNoHow does your child relate to other family members?*Please describe any alienations/frictions in the family that you think we should be aware of:*Describe any fears or anxieties your child may have/has had in the past. If possible, relate these to any significant events in their life, e.g. new baby, moving house, divorce, deaths, accidents or hospitalizations:*Describe briefly your child's adjustment to school, Sunday School, camp or any other group activities, seperate from family events. Include how he/she reacts to counselors, teachers, peers and their parents:*Does your child have a room alone at home?*YesNoIf not, with whom do they share?*Does your child have any medical diagnosis which we should be aware of?* Yes No Enter Details*If so, please upload associated Medical Files* Drop files here or Were there any significant events during pregnancy or delivery?* Daily RoutineWhat time does your child get up?*What time do they go to bed?*Do they sleep well during the day?*Do they sleep well at night?*Do they have a place to play outdoors?*Do they have any food dislikes?*Does your child have any special needs or limitations? Glasses Hearing-Aid Orthopedic Shoes/Braces Medication Observation for Seizures Motor Difficulties Language Problems Learning Disability Personal HistoryWas your child adopted after the age of 6 weeks?*YesNoIf so, what age?*Are there any significant features of adoption that the school might need to be aware of i.e emotional/medical?*When your child was very young, were you ever concerned about motor or language development?*YesNoIf so, please explain the area of concern (e.g walked/talked late, wore braces for orthopedic reasons)*Is your child:*Right HandedLeft HandedAmbidextrousDon't know yetDid they ever switch hands after 2 1/2 years?*YesNoIs there anything else you think we should know about your child?
