Admission

To which location do you wish to enroll your child?

Child’s data

Name and surname *

Date of birth *

Address of residence *

Gender *

Nationality *

Country of origin *

What languages does your child understand / communicate in?

Child has attened nursery *

YES NO

Child has attened preschool *

YES NO

If yes, please write the name and location of the nursery / preschool

Siblings (name and date od birth) *

Parents’ data

Mother’s name and surname *

Father’s name and surname *

Mother’s telephone numer *

Father’s telephone number *

Mother’s e-mail address *

Father’s e-mail address *

From when would you like your child to start attending the school? *

How did you get to know about our school? *

Are you familiar with the philosophy of Attachment Parenting and do you use it at home?

Questions about your child

My child has difficulties with:

staying focused connecting with peers sharing agression following rules none of abovementioned

How does your child communicate?:

makes a noise points with finger uses single words uses whole sentences

Does your child have a nap during a day? If so, what time? *

Does your child use a dummy? *

Does your child use toilet independently? *

What type of activities does your child usually choose:

Art activities (drawing, coloring, cutting) games with numbers phisical games (jumping, running) blocks/puzzles dolls/teddies cars/trains watching cartoons

other:

What does your child not like?

Are there any situations / things your child is afraid of?

How does your child react on unexpected change of plans / day routine?

Has your child ever had a contact with other children? *

YES NO

What does your child prefere *

Does your child suffer any disease (eg. chronic disease, postural defects, vision impairment, speech impediment, hearing loss or developmental disorders? *

Does your child have a sensory integration disorder? *

YES NO

Does your child suffer any food selectivity? *

YES NO

Does your child have any allergies? *

YES NO

Has your child been under the care of a psychological / pedagogical counseling center or has used any form of therapy? If so, please state the reason

Other important information about your child

How can we help your child during first days at our preschool?

When and what type of primary school would you like your child to go to? *

at the age of 7 to grade 1 in Polish primary school at the age of 6 to grade 1 in international school

Thank you for completing the questionnaire. In accordance with art. 13 of the Regulation (EU) 2016/679 of the European Parliament we would like to inform you that the Preschool collects and processes personal data of your child and family members for the needs of recruitment process, as well as educational, care and teaching purposes. Please, be informed that you have the right to access your data and the right to rectify them, delete them, limit their processing, the right to data transfer, the right to object, to withdraw your consent at any time without affecting the legality of processing.

I have read the information regarding the collection and processing of personal data of me and my family members. I declare that all data is true and I hereby agree to the processing of my personal data and my child's data for the purposes of recruitment as well as for educational, care and teaching purposes.

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Admission

Questionnaire for parents applying for admission of their child to In Harmony Preschool

Child’s data

Parents’ data

Questions about your child