Student Information Form

This information is helpful to us in placing children with the correct teaching team and providing information to your child’s teachers at the beginning of the school year.

If you have any issues or questions, please contact our Director, Kerry Bresee.

Student Full Name

First Name

Last Name

What is the primary language spoken at home?

Is your child potty trained

Yes

In Progress

No

Parent #1 Name

First Name

Last Name

Parent #1 Occupation

Parent #2 Name

First Name

Last Name

Parent #2 Occupation

Does your child have any allergies?

Yes

No

If yes, what is your child's reaction to the allegen?

What is the treatment for exposure to the allegen?

Does your child currently receive support or services outside of school (OT, PT, Speech etc.)?

Please list three strengths that you see in your child?

What are some areas of growth you would like to see in your child this school year?

Parent's Digital Signature

Please fill out your full name. This will function as your signature.

Note: Glenn School for Young Children operates under an exemption from licensing, granted by Bright from the Start. We do carry liability insurance and comply with criteria and requirements for exemptions in Rule 591-1-1-.46(1)(a) Exemption Requirements and Rule 581-1-1-.46(1)(b) Exemption Categories.

Student Information Form

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