Sample Forms are the Teacher's Section of the by dor13365


  Sample Forms are the Teacher’s Section of the Guidelines

Sample Forms are exactly what they claim to be – just samples. The
majority deal with Pre-School and Kindergarten.

                  They are inclusive of many areas:





                    Early Childhood Classrooms

All may be copied, changed or adapted in any way to meet specific or
general needs.

It is suggested that as forms are used/changed – old forms be taken
out and new ones inserted.

                          CLASSROOM CHECKLIST
Does your classroom have:

_____ A cubby for each child which is labeled with his/her name and an identifying
      feature such as a sticker or picture?

_____ Attractive display of children’s work?

_____ Clear division between quiet and noisy areas?

_____ Material stored near their place of use?

_____ Materials which are clean, whole and in good repair?

_____ Materials stored in clean, open containers which are visually labeled?

_____ Shelves which are visually labeled?

_____ Shelves which are uncluttered and provide enough space for children to
      easily open and return materials?

____   One material in one container as opposed to mixing logos with beads?

____   Duplicates of many items, especially in classrooms for 2 year-olds and
       young 3 year olds?

____   Some centers which provide a clearly defined private workspace; i.e. trays,
       placemats, carpet squares?

____   Clear visual cues as to the number of children who may use the center at any
       one time?

____ Closed teacher storage which is clearly separate from shelves the children
     may use?

___    Tops of shelves and cubbies which are clear, clean and uncluttered?

___    Bright, simple wall display at children’s eyelevel?

Planning for the arrival of a new group of children must begin months in advance.
Schools often have their own procedures for registration and admittance. But with the
approval of the school’s administrator, there are techniques a teacher can use to orient
parents and children to the beginning activities of school. Also included are ideas that
will help the teacher in classroom preparation and management.

                               PARENT ORIENTATION

Assuming that letters containing general school policies have been sent to the parents, the
teacher will still need to have more personal contacts with parents when school begins.
Listed below are possible ways to attain this goal.

   •   Letters sent to parents asking them to attend a general meeting.

   •   A questionnaire given to the parent to aid the teacher to become better acquainted
       with the child (allergies, medications, signs of talent, likes and dislikes, etc.).

   A hand book containing pertinent information:

   •   Introductory letter asking parents for their involvement.

   •   An explanation of the goals, objectives and procedures of the program.

   •   An explanation of the curriculum, progress reports and parent-teacher

   •   A periodic newsletter so parents will be aware of what is happening in the

   •   A general schedule of the child’s day.

   •   Procedures for snack time.

   •   List of special things the parent of the child can do (label child’s belongings,
       bring in paint shirt and tote bag, etc.).

   •   A medical chart.

Prior to the first day of school, have a parent orientation meeting. This will give you a
change to present your program and for parents to ask their questions. Establish some
type of staggered entrance schedule for the first day of school. This will be helpful for
you, the parent and the child


  •   Philosophy

  •   Parent/Staff Communication
                    Daily communication                    parent communication
                    Conference meetings                    involvement

  •   Daily schedule/curriculum

  •   Signing in/out and absences

  •   Lunch
                    Policies              visiting               practices

  •   Birthdays

  •   Naptime/rest time

  •   Sick child policy

  •   Medication policy

  •   Early drop-off/late pick-up policy (if applicable)

  •   Discipline policy

  •   Forms and areas to introduce
                  Accident reports               School calendar

  •   Things to remember
                   Extra clothes (labeled)
                   Lunch (if applicable)



Conference attended by:____________________________________________________

Parent of:________________________________________________________________

Describe the basic achievement level of this child. Any particular strengths or needs?





What physical growth factors concerning this child should be considered?



What can be said of the general social and emotional growth of this child?



What was accomplished through this conference?________________________________


Parent input helpful for instructional planning:__________________________________


Other comments:__________________________________________________________




Dear Parents,

        Parent-Teacher conferences are currently being scheduled for the Early Childhood
classes. Together, we can look at what the children have already learned and established
some goals for the rest of the year.

        Conferences will be on__________day&date__________for the four-year-olds
and on _________________day & date_____________for the three-year-olds. We ask
that children NOT be present during the conference. The conference will be held in your
child’s classroom.

        The following appointment has been made for your Parent-Teacher Conference.
May we ask that you that you make every effort to adjust your schedule to keep the
appointment given to you as listed below. We could make a change for you in case of
necessity or emergency, but such an adjustment may involve several families. If
however, it is impossible for you to come at the appointed time, please call the school
office by date, BEFORE 3:00 p.m.

       Please be prompt for your conference. If you do not feel that sufficient time was
given to you for your conference, another appointment can be scheduled at a different

       Please return the lower portion of this letter as soon as possible. We thank you
for your cooperation.



I will be there at the appointed time               yes_______             no_________

_____I cannot come at the appointed time. I will phone for another appointment.

                                                      PARENT SIGNATURE

                            EARLY CHILDHOOD
                           INFORMATION SHEET

        Child’s Name____________________________Birthdate_____________


           Father’s Name____________________________Phone(work)_________


           Type of Work____________________________Work Hours__________

           Mother’s Name___________________________Phone(work)_________


           Type of Work____________________________Work Hours__________


Persons to whom the child is to be released:

1. Name________________________Address_________________Phone_________

2. Name________________________Addres__________________Phone________




2. Name_____________________________________Relationship______________


   Family Physician___________________________Phone____________________


I understand that I will be notified of field trips and that my child will be taken from

school grounds on these excursions. I give my permission for __________________
                                                                 (Child’s Name)
to accompany the class.


       1. What are your child’s favorite toys?__________________________________

           Does your child have a pet?_________If so, what?______________________

       2. How many hours a day does your child watch T.V.?_____________________

           What programs does he/she view?___________________________________


       3. What is the usual bed time hour?____________________________________

       4. Does your child have any habits such as thumb sucking, nail biting or others?
          Please describe.__________________________________________________


       5. Does your child have any particular fears or nightmares?__________________


       6. Does your child use any expressions that may not be understood by others
       (such as “wee-wee”) for urine?_________________________________________


       7.. What is your usual method of reassuring and rewarding your child_________


       8. What is your “philosophy” of disciplining your child?____________________


Get Acquainted Forms – continued…..

   9. Does your child have any allergies?_____________________________________

   10. Is your child under any medication or therapy?___________________________


   11. What foods does your child enjoy?_____________________________________

   12. Please list names, relationships and ages of brothers and sisters and other
       members who live in the home:



                           AUTHORIZED PICK UP LIST
      For your child’s protection, please fill out the name of authorized persons to
      bring, or take your child from the school, other than yourself. If you can’t do this
      now, do it at the start of the school and whenever any changes are in order.
      Please inform the authorized persons to be prepared to identify themselves to our
      staff. Please list parent other than one who signed this, if authorized to pick up.

      NAME:_______________________ RELATIONSHIP TO CHILD___________

      NAME:_______________________ RELATIONSHIP TO CHILD___________

      NAME:_______________________ RELATIONSHIP TO CHILD___________

      NAME:_______________________ RELATIONSHIP TO CHILD___________

      In case of a car pool arrangement, designated such on the line “relationship” or
      tell us here what the arrangement will be:________________________________




      Is there anyone who might come for your child to whom you do NOT wish to
      have your child released (other parent, for instance)?_______________________




                            EXPOSURE NOTICE


Dear Parent:

Your child may have been exposed to the disease checked below on______________.
Please read that section and follow the guidelines.

                        EARLY SIGNS OF INFECTION

   •   CHICKENPOX - Onset is 2 to 3 weeks after exposure. Symptoms: Slight fever
       and irritability for 1 day, and fine blisters on the trunk and face. Your child is
       contagious for up to 5 days. Do not bring your child to group care for 5 days after
       the rash appears or until all scabs dry, whichever is first.

   •   STREP - (including scarlet fever and strep throat) – Onset is 2 to 5 days after
       exposure. Symptoms: Sore throat, fever and occasionally a rash. Consult your

   •   GERMAN MEASLES (rubella) – Onset is 2 to 5 days after exposure.
       Symptoms: Slight head cold, swollen glands at the back of the neck, and a
       changeable rash that goes away in 2 to 3 days. KEEP YOUR CHILD AWAY
       Do not bring your child to group care for 7 days after the rash begins.

   •   MEASLES –(rubeola) – Onset is 1 to 2 weeks after exposure. Symptoms:
       Runny nose, watery eyes, fever (may be quite high), and a cough; a blotchy rash
       appears about the fourth day. Do not bring your child to group care for 4 days
       after the appearance of the rash or until she/he is well.

   •    MUMPS – Onset is 14 to 26 days after exposure. Symptoms: Pain in the cheeks,
       which is increased by chewing, swelling over the jaw and in front of the ear. Do
       not bring your child to group care until all swelling disappeared or 9 days after
       swelling appears.

   •   PINWORMS – Itching of the anal area, especially at night, is the most common
       sign. Your child may have insomnia or nightmares and may lose his/her appetite.
       Consult your physician. Observe other members of the family for symptoms.

EXPOSURE NOTICE continued…..

  •   HEAD LICE – For 2 weeks after exposure, observe your child’s hair and scalp at
      his/her neckline and around his/her ears for eggs or nits (tiny, pearly white egg
      shaped objects) that stick slightly to hair shafts. (Your child may also complain
      of an itchy head). Consult your physician or pharmacist for treatment. Do not
      bring your child to group care until the day after treatment begins. Carefully
      check other members of the family for eggs or nits.

  •   CONJUNCTIVITIES (pink eye) - Onset is 24 to 62 hours after exposure.
      Symptoms: Irritated tearing eyes: swollen lids; and yellow mucus discharge that
      makes the eyes sticky. Very contagious if the conjunction is caused by infection.
      Children under 5 are most susceptible. Consult your physician. Do not bring
      your child to group care until the day after treatment begins.

  •   IMPETIGO – Onset varies. Symptoms: Golden Crusty sores or pimple-like
      spots develop watery heads, break and form crusted areas; may occur on hands,
      legs, feet or buttocks. Spreads rapidly if left untreated. Consult your physician.
      Do not bring your child to group care until the day after treatment begins.

  •   RINGWORM (scalp) - Onset varies. Symptoms: Bald oval shapes on the scalp;
      grayish scales; broken hair; itching. Do not bring your child to group care until
      the day after treatment begins. Be cautious of sharing items that come in contact
      with head.

  •   RINGWORM (body) - On set varies. Symptoms: Rounded, reddish area with a
      scaly or blistery border, often itchy. Do not bring your child to your group care
      until, the day after treatment begins. Cover sores with clothing or a dry bandage

                            ACCIDENT REPORT

Child’s Name_______________________________________Birth Date_____________

Class________________________ Date:_________________Time:________________

What Happened: (Be as objective as possible)___________________________________




Teacher(s) who saw what happened___________________________________________

Teacher who treated injury_______________________________Teacher who informed

parents____________________________________Date reported___________________

Time reported________________________-Staff signature________________________

Parents signature______________________

                       UNUSUAL INCIDENT REPORT

Child’s Name__________________________________Birth Date_________________


What Happened? (Be as objective as possible)__________________________________



Teacher(s) who saw what happened___________________________________________

Teacher who intervened_____________________Teacher who informed parents_______

____________________________Date reported_________________________________

Time reported_________________________Staff signature_______________________

Parent signature_________________________________________



Language & Listening                                                Yes   No
     1. Recognizes own name.                                        ___   __
     2. Knows age.                                                  ___   __
     3. Names several objects.                                      ___   __
     4. Writes first name.                                          ___   __
     5. Identifies 8-10 alphabet letters.                           ___   __
     6. Follows simple oral directions                              ___   __
     7. Uses coherent sentences.                                    ___   __
     8. Enjoys stories & words.                                     ___   __

     1. Recognizes 8 basic colors.                                  ___   __
     2. Recognizes 4 basic shapes.                                  ___   __
     3. Demonstrates one-to-one correspondence.                     ___   __
     4. Counts by rote to 10 or more.                               ___   __
     5. Counts 10 or more objects.                                  ___   __
     6. Identifies numerals 0-5.                                    ___   __
     7. Classifies and/or sorts objects.                            ___   __
     8. Utilizes materials to build.                                ___   __
     9. Utilizes reasoning & problem solving.                       ___   __

      1.    Demonstrates the ability to move using large muscles.   ___   __
      2.    Uses writing utensils appropriately.                    ___   __
      3.    Uses scissors correctly.                                ___   __
      4.    Demonstrates good eye/hand coordination.                ___   __

      1.    Expresses self thought art media.                       ___   __
      2.    Participates in singing.                                ___   __
      3.    Participates in movement activities.                    ___   __
      4.    Participates in dramatic play.                          ___   __
      5.    Uses imagination & creativity.                          ___   __

Pre-School Assessment Checklist….continued…

Personal & Social Development                              Yes     No
      1. Is comfortable with self.                         ___     __
      2. Is aware of own abilities                         ___     __
      3. Communicates wants & needs.                       ___     __
      4. Works/plays independently.                        ___     __
      5. Participates in large group activities.           ___     __
      6. Participates in small group activities.           ___     __
      7. Respects other children’s feelings & abilities.   ___     __

Children’s Comments:_____________________________________________________




Teacher’s Comments______________________________________________________




“ALL ABOUT ME”           My Skills Record        ______School Year
                            Three & 4 Years Old
My name is________________________________My age is_____________________

Usually     Working On It   Experiencing
Does This   Now, I Need     Difficulty
Well        Help
                                            Going to the toilet by myself.
                                            Listening to others when it is their turn talk.
                                            Telling what I want or need.
                                            Following simple directions.
                                            Attending to a task.
                                            Helping with pick up and clean up.
                                            Playing with other children.
                                            Taking turns and sharing.
                                            Speaking in sentences of five or more
                                            Identifying red, yellow green and blue.
                                            Reciting rhymes, singing songs.
                                            Telling how things are alike and different.
                                            Identifying a circle, square, triangle and
                                            Recognizing numbers 1 – 10.
                                            Counting from one to ten.
                                            Identifying a few letters of the alphabet.
                                            Throwing and catching a ball.
                                            Using crayons with control.
                                            Using scissors with control.
                                            Working a puzzle.
                                            Tracing my first name on a dot to dot.

Teacher’s comments:______________________________________________________


Attending_______________School___________          Not attending___________School

Teacher Signature______________________________Date_____________________

A.      General Work Skills

        1. Have I imparted a positive feeling about my job by arriving at school each day
           on time with an enthusiastic and cheerful attitude and dressed professionally?

                               ALWAYS                 USUALLY                SELDOM

        2. Have I accepted suggestions from others gracefully?

                               ALWAYS                 USUALLY                SELDOM

        3. Have I been able to retain my composure in tense situations?

                               ALWAYS                 USUALLY                SELDOM

        4. Have I made an effort to expand my knowledge of children by attending
           suggested workshops and reading recommended materials?

                               ALWAYS                 USUALLY                SELDOM

        5. Have I been conscientious in my attendance and use of sick leave?

                               ALWAYS                 USUALLY                SELDOM

        6. Have I assumed my share of joint responsibilities?

                               ALWAYS                 USUALLY                SELDOM

        7. Have I been willing to participate in school activities outside of regular school

                               ALWAYS                 USUALLY                SELDOM

     B Relationship to Parents, School and the community

           1. Have I made an effort to get to know the students’ parents?

                               ALWAYS                 USUALLY                SELDOM

           2. Have I conveyed to parents a genuine interest in and concern for their
              child as unique individuals?

                               ALWAYS                 USUALLY                SELDOM

Relationship to parents, the school and the community, continued….

          3. Have I been discreet in discussing families outside of the school?

                             ALWAYS                 USUALLY                SELDOM

          4. Have I been loyal to the school and its philosophy?

                             ALWAYS                 USUALLY                SELDOM

          5. Have I carried positive and professional attitudes about the school into my
             community activities?

                             ALWAYS                 USUALLY                SELDOM

   C. Relationship to Students

          1. Have I greeted my students in a friendly and pleasant manner?

                             ALWAYS                 USUALLY                SELDOM

          2. Have I remembered to use a soft pleasant voice?

                             ALWAYS                 USUALLY                SELDOM

          3. Have I looked for the strengths and special qualities in each child?

                             ALWAYS                 USUALLY                SELDOM

          4. Have I treated students with tact and respect?

                             ALWAYS                 USUALLY                SELDOM

          5. Have I helped each child develop friendships?

                             ALWAYS                 USUALLY                SELDOM

          6. Have I remembered to really listen when a child talks?

                             ALWAYS                 USUALLY                SELDOM

          7. Have I provided opportunities for the shy or quiet child to participate in a
             conversation or activity?

                             ALWAYS                 USUALLY                SELDOM

Relationship to students….continued….

         8. Have I encouraged independence in students?

                            ALWAYS                 USUALLY                SELDOM

         9. Have I allowed time for students to do their own work rather than
            doing it for them?

                            ALWAYS                 USUALLY                SELDOM

         10. Have I stated the rules in a positive way?

                            ALWAYS                 USUALLY                SELDOM

         11. Have I given directions specifically so that students know what they are
             supposed to do?

                            ALWAYS                 USUALLY                SELDOM

         12. Have I allowed the children to make choices when appropriate?

                            ALWAYS                 USUALLY                SELDOM

         13. Have I gone to where the child is to talk to him/her on their eye level?

                            ALWAYS                 USUALLY                SELDOM

         14. Have I remembered to smile?

                            ALWAYS                 USUALLY                SELDOM

         15. Have I conveyed confidence in the child’s ability to succeed?

                            ALWAYS                 USUALLY                SELDOM

         16. Have I maintained an overview of the classroom?

                            ALWAYS                 USUALLY                SELDOM


To top