ORIENTATION QUESTIONNAIRE

This form is given to your child's teacher before the school year begins.

Child's Name *

First

Middle

Last

Child's Hebrew Name *

Is your child called by any other name?

What is your child’s primary language?

Is your child toilet trained? *

Does your child have any allergies? *

Is your child on any medication? *

Is your child on a special diet? *

Is your child receiving any special services (i.e. speech therapy, occupational therapy etc.)? *

Who will be bringing your child to school? *

Who will be picking up your child from school? *

Does your child have any siblings? If so, what are their ages?

Please indicate any special talents, resources or skills either parent can bring to the classroom:

Is there anything else you would like to tell us about your child?

IMPORTANT:

Please send an individual photo of your child and a family picture that will be displayed on the classroom family bulletin board.

You can email the photos to:
secretary@chabadwestside.org,
or mail them to:
Chabad ELC
170 West 97th St.
New York, NY 10025