Highland Pre-School Enrollment Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Choose Program Year2021-20222022-20232023-20242024-2025Time Preference (Classes are 1/2 Day Monday-Friday)A.M.P.M.Child's First, Middle, Last NameHome Phone NumberSexMale FemaleDate of BirthSchools District of ResidenceCountyStreet AddressCityZipMailing Address (If Different)Does your Child Have an IEPYesNoIf your child has an IEP, which school district is it through?What is the language primarily spoken in the home?Are there custody papers regarding this child?YesNoIf yes, who is the residential Parent?Who does the child live with?Mother, FatherMotherFatherGrandparentsMother, Step-FatherFather, Step-MotherFoster FamilyAdoptive FamilyOtherIf other, list who the child lives with.Parent/Guardian's First and Last NameRelationship to ChildHome/Cell Phone NumberEmail Address2nd Parent Guard First and Last NameRelationship to ChildHome/Cell Phone NumberDoes your child have any health/physical problems that we should be aware of? Please provide documentationHas your child had a recent vision/hearing assessment?YesNoDoes your child have a history of ear infections?YesNoDoes your child receive Speech, Occupational Therapy, Physical Therapy, or Vision Therapy?YesNoIf yes, where?Developmental Questions: Do you have concerns with your child tripping or falling frequentlyYesNoDoes your child bump into things or seem unaware of their surroundings?YesNoDoes your child avoid playing on the playground equipment (like swings, slides, climbing equipment)?YesNoIs your child able to: hold a crayon and color/drawYesNoPull their zipperYesNoComplete simple puzzles?YesNoImitate Song Movements with his body, hands, and armsYesNoDo they drink out of a regular cup?YesNoDo they use silverware?YesNoDo they dress/undress themselves?YesNoHow does you child communicate?body languagegesturessign languagevocalizationswordssentencesIn a percentage, how much of your child's speech do you understand? How many words does your child use?What types of errors do you notice your child making?Can your child express his/her wants, needs, and feelings with you?Does your child understand most sentences you say?Can your child point to most objects you name?Can your child follow simple directions?Does your child answer simple WHO, WHAT, WHERE questions?Submit Home 9 Pre-School Enrollment
