School Entry Inventory

SCHOOL ENTRY INVENTORY
Surname: Legal First Name:

Middle Name: Name Commonly Used:
Birthdate: Name of School:
Notice of Collection of Personal Information

Personal information on this form is collected under the authority of the Education Act and its regulations, and in accordance with the
Municipal Freedom of Information and Protection of Privacy Act and the policies and procedures of the London District Catholic School
Board. It will be used for educational, health and welfare purposes affecting the student and will be retained in the OSR until the end of
Grade 3. Questions or concerns about the collection of data on this form should be directed to the principal of the school.
1. Other people in the house:
Name Relationship to Child Age / Grade
2. Language(s) spoken at home: English? Yes ❑ No ❑ Other:

Language(s) spoken by mother: English? Yes ❑ No ❑ Other:
Language(s) spoken by father: English? Yes ❑ No ❑ Other:
What language, other than English, does your child speak?
3. How often do you read to your child in any language?

Does your child enjoy being read to? Yes ❑ No ❑
Please comment:
4. Preschool Experiences:
YES NO
Childcare
Camp
Nursery School
Babysitter
Other
Will your child be attending the extended day / before and after school program provided at this school?
Yes ❑ No ❑
5. Has your child experienced any of the following?
Condition Yes No If yes, please comment

Accidents (e.g., falls)
Allergies
Asthma
Birth Complications
Bowel/Bladder Infections
Ear Infections
Seizure Disorder
Fainting Spells
Headaches
Nose Bleeds
Skin Irritations
Sleep Problems
Surgery
Other
Other
** For questions 6, 7, and 8, please provide copies of any relevant written documentation. **
6. Has your child ever had a medical diagnosis that would have an effect on school performance?
Yes ❑ No ❑
Please comment:
Date of last full medical:
7. Do you have any concerns about your child’s hearing? Yes ❑ No ❑

Please comment:
Has your child had a hearing test in the past year? Yes ❑ No ❑
Date: Results:
8. Do you have any concerns about your child’s vision? Yes ❑ No ❑
Please comment:
Has your child had a vision assessment in the past year? Yes ❑ No ❑
Date: Results:
9. When did your child learn to talk?
10. When did your child learn to walk?

11. Does your child require any medication? Yes ❑ No ❑
If yes, please identify:
Will the medication need to be administered at school? Yes ❑ No ❑

** If yes, please obtain a copy of the School Board’s medication procedural guidelines. **
12. Is there any physical activity in which your physician has indicated your child should not participate?
Yes ❑ No ❑
If yes, please comment and forward the necessary doctor’s certification:
13. Do you understand your child’s speech? Yes ❑ No ❑

Please comment:
14. Do people outside your home understand your child’s speech? Yes ❑ No ❑
Please comment:
15. Has your child ever been seen by a Speech-Language Pathologist? Yes ❑ No ❑
If yes, please give details (name, when, where):
16. Has your child ever been seen or assessed by any outside agencies (e.g., nutritionist, psychologist or therapist)?
Yes ❑ No ❑
If yes, please give details (name, when, where):
17. In what types of social / recreational activities has your child been involved (e.g., dance lessons, music, lessons, sports
activities, swimming, etc.)?
18. Is your child able to perform the following independently?
Skill Yes No Comment

Dressing Self
Toileting
Washing Hands / Face
19. Does your child have any behaviours about which the school needs to be aware (e.g., tantrums, runs away, biting)?
Yes ❑ No ❑
Please explain:
20. How does your child react to new situations / transitions?
21. Are there any situations that might frighten your child (e.g., the dark, dogs, thunderstorms)?
Yes ❑ No ❑
Please explain:
What have you found to be effective in helping in these situations?
22. Has your child experienced any significant changes/ disruptions in his/her life in the past?
(e.g., birth of a baby, death of a family member, moving, separation or divorce or parents, etc.)
Yes ❑ No ❑
Please comment:
How has your child reacted to this change?
22. Is there anything else that you would like to share that would help in planning your child’s transition to school?
Yes ❑ No ❑
If yes, please comment:
Completed by: Date:

School Entry Inventory - 2022-2023

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Surname: Legal First Name:

Notice of Collection of Personal Information

1. Other people in the house:

Name Relationship to Child Age / Grade

2. Language(s) spoken at home: English? Yes ❑ No ❑ Other:

3. How often do you read to your child in any language?

Condition Yes No If yes, please comment

7. Do you have any concerns about your child’s hearing? Yes ❑ No ❑

8. Do you have any concerns about your child’s vision? Yes ❑ No ❑

9. When did your child learn to talk?

10. When did your child learn to walk?

Will the medication need to be administered at school? Yes ❑ No ❑

13. Do you understand your child’s speech? Yes ❑ No ❑

18. Is your child able to perform the following independently?

Skill Yes No Comment

What have you found to be effective in helping in these situations?

How has your child reacted to this change?

If yes, please comment:

Completed by: Date:

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