2024-2025 Student Info Sheet

Student Name *

Date of Birth * +

Please call my child *

Was your child premature? *

Parent/Guardian Name *

Phone Number *

Occupation *

Parent/Guardian Name *

Phone Number *

Occupation *

Sibling's Names and Ages *

Does child live with one or both parents? Explain *

Home Address *

Email Address for Teacher/Office Communication *

Names and Phone Numbers of Persons Authorized to pick up your child (including parents of child) *

Are you a member of New Hope Church? *

Is your child receiving any services for speech, hearing, or occupational needs? If yes, please describe *

What language do you speak at home? *

Food or other allergies (including environmental and seasonal) *

Does your child have fears? If so, please explain. *

Are there any holidays in which you do not participate? *

What are your child's favorite activities? *

What hopes or expectations do you have for your child from our program? *

Any other information that you feel would be beneficial for us to know? *