Home Information Form – Reception

Child's Name *

First

Last

Date of Birth//

Date of Entry *

Nationality *

Religious Denomination *

Has your child received their 2 and a half year check? If yes, please specify the results here (you can find this information in your child's red book). *

Has your child received their school entry review into Reception class? If yes, please specify the results here (you can find this information in your child's red book). If not, we will undertake our own review for our records. *

Please give details of your child's previous playgroup / nursery experience. Please give details of setting, sessions and experience. *

Are there any siblings? If yes please specify their ages. *

Does you child play happily with other children? *

Is your child happy to be left in the care of another adult and can they manage without you? *

Is there anything in particular to note about your child's birth and very early development? *

When did your child begin to walk and crawl? *

When did your child begin to form recognisable words and at what age did your child start to communicate in full sentences? *

Has your child received any form of speech therapy (SALT)? If yes, please give details. *

Is English your child's first language? Does your child speak any other languages at home? *

Does your child wear glasses? *

Yes
No

Has your child visited an optician prior to starting school? We recommend that children are seen before starting school. *

Yes
No

Date of last Optician visit (if applicable).

When were your child's teeth last examined? Please note any issues below. *

Has your child received a hearing test in the last 6 months? If yes, please give the date of the last hearing test. We recommend that all children are seen prior to starting school. *

Yes
No

Date of hearing test.

Does your child have any cultural or religious dietary needs? *

Does your child have any other specific dietary needs? *

Children starting in The Nest and Reception are expected to be fully toilet trained (no nappies).

My child is toilet trained (no nappies). *

My child can undress/dress without help *

My child is fully independent going to the toilet *

If you have indicated your child requires help sometimes, please give more details here. Or specify 'none' if not applicable. *

Has your child established left or right handedness? *

Is there anything that makes your child worried or anxious? *

Do you or your child have any concerns about starting school? *

Is there anything else that you wish to let us know?

Have your contact details changed from those on the Registration Form? Please give details here if so.

Parent / Guardian confirmation

Name of Parent/Guardian completing the form *

First

Last

Date

Email *