Individualized Family Communication Plans

Tell Me A Little Bit About Your Child

All information will be kept confidential.

Your Name: Jason Segers_________________________________________________________

Your Child’s Name: Irene Segers___________________________________________________

Nicknames: None_______________________________________________________________

Does your child have allergies or any other health conditions we should be aware of?

No.___________________________________________________________________________

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What is the most important thing I should know about your child?

She learns best with hands-on activities.______________________________________________

_______________________________________________________________________________

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Briefly describe your child’s personality.

She is very stubborn and likes to do things her way. But she is also very kind, always willing to share

toys or treats with other children.______________________________________________________

What are some of your child’s favorite activities?

Irene likes being outdoors and running around the park. She likes to dance and put on little skits._

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How will your child get home from school (bus, carpool, other)? Car__________________________

Is there anyone else who will regularly pick up your child from school?

Her nanny_________________________________________________________________________

Her mother every other Monday, Wednesday, and Friday___________________________________

__________________________________________________________________________________

Please share any other information that you think will be important for me to know.

Her mother and I recently separated, and it’s been hard on Irene. If she acts out somewhat, that may

be the reason. Please let me know if she does._____________________________________________

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Tell Me A Little Bit About You and Your Family

Do you speak another language at home? If so, which one?

Her nanny is fluent in Spanish and English, but I don’t speak any other languages to her besides____ English.____________________________________________________________________________

Do you read to your child? How often?

Her nanny reads to her before bed during the week. I try to read to her during the weekends. I’m not sure if her mother does.________________________________________________________________

Who else lives at your house (grandparents, siblings, pets, etc.)?

No one; just the two of us.______________________________________________________________

What is your preferred method of communication (email, phone call, note, meeting, etc.)?

Email____________________________________________________________________________________________________________________________________________________________________

How would you like to be involved in our classroom? Please check all that apply.

_X_ Cut out materials at home

___ Help at class parties/events

___ Help make art projects and crafts

___ Attend field trips

___ Other ________________________________________________________________

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