Reach Developmental Preschool Information Form

Child's Name*:

Date of Birth*:

Do you have any concerns about your child’s development in any of the following areas? If so, please provide additional information including the type of support you feel your child will require.

SOCIAL SKILLS (sharing, taking turns, playing with others, etc.)
YesNo

COMMUNICATION SKILLS (verbal skills, gestures/sign language, understanding basic concepts, following directions, etc.)
YesNo

GROSS MOTOR SKILLS (walking, running, climbing, etc.)
YesNo

FINE MOTOR SKILLS (use of scissors, drawing materials, puzzles, peg toys, etc.)
YesNo

SELF-HELP SKILLS (toileting, grooming, dressing, etc.)
YesNo

What are your expectations for your child while attending preschool? (i.e. increased social skills, ability to play with toys appropriately, understanding of basic concepts, etc.)?

Parent(s) / Guardian(s) Signature*:

Parent(s) / Guardian(s) Email*:

Date*:

_{Any personal information provided to Reach Child and Youth Development Society is collected and used in accordance with British Columbia’s Personal Information Protection Act (PIPA). For details of our privacy policy, please contact us at 604-946-6622, or email inforeachdevelopment.org}

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