Calvary Temple Christian Academy


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CALVARY ACADEMY

1133 E County Line Rd Lakewood NJ 08701-2196 Phone: 732-363-3633 Fax: 732-363-7337 Business Office: 732-363-1655 Web: www.calvaryacademy.org

Kindergarten Questionnaire/Reference Name of Student:

Date: _________________________

Name of Present School/Daycare: ___________________________________________________________________ Address: _______________________________________________________________________________________ Name of Teacher:

Teacher Signature: ___________________________

The parents of the student listed above have requested that Calvary Academy consider their son/daughter for admission. The school admissions office would appreciate your prompt response to the information requested. Your assistance is essential in evaluating the applicant in relation to our academic program. Please complete the appropriate section and mail this form in the enclosed envelope. Thank you for your assistance in helping us become better acquainted with this student.

To be completed by a former teacher or daycare provider (Sunday School teachers may be considered only if a pre-school teacher is not available) 1. Does this child have any health, emotional, or psychological problems?

 Yes  No  Not Sure

(If yes please describe in the comment section)

2. Does he/she have normal vision?

 Yes  No  Not Sure

3. Does he/she have normal hearing?

 Yes  No  Not Sure

4. Is this child moody? (depressed at times, exhilarated at times)

 Yes  No  Not Sure

5. Does this child exhibit temper tantrums?

 Yes  No  Not Sure

6. Normally, does this child obey his/her parents?

 Yes  No  Not Sure

7. Is this child respectful when spoken to by parents & adults?

 Yes  No  Not Sure

8. Is he/she overly aggressive (fighting, pushing, demanding)?

 Yes  No  Not Sure

9. Can others easily understand the child when he/she speaks?

 Yes  No  Not Sure

10. Does the child pay attention to a short story when being read to?

 Yes  No  Not Sure

11. Is the child able to color a picture beyond scribble?

 Yes  No  Not Sure

Kindergarten Reference 2014/15

12. Is the child able to zip or button up a jacket?

 Yes  No  Not Sure

13. Is the child able to easily detach from the parent when entering the class?

 Yes  No  Not Sure

14. Is the child able to put together a simple puzzle?

 Yes  No  Not Sure

15. Is the child able to listen to and follow 2-step instructions?

 Yes  No  Not Sure

16. Can the child hold a pencil correctly?

 Yes  No  Not Sure

17. Can the child cut with scissors?

 Yes  No  Not Sure

18. Can the child recognize and name at least 6 colors?

 Yes  No  Not Sure

19. Can the child take care of his/her own bathroom needs?

 Yes  No  Not Sure

20. Can the child recite and follow classroom rules & procedures?

 Yes  No  Not Sure

21. Is the child able to attend a task for several minutes or until finished?

 Yes  No  Not Sure

22. Does your preschool provide any Christian training?

 Yes  No

23. Does this child show any interest in spiritual matters?

 Yes  No  Not Sure

24. Has the child been excessively absent/tardy?

 Yes  No  Not Sure

Circle the words that best describe this child: very quiet

sometimes shy

somewhat active

highly active

friendly

cautious

risk-taker

talkative

aggressive

curious

moody

creative

Comments:

This child appears to be ready for kindergarten.

 Yes

 No

 Questionable

Childhood should be a journey not a race. st

Children should be 5 years old on or before September 1 .

Kindergarten Reference 2014/15