Transcript Intakeformulier - OBS Dick Bruna

Intake formulier OBS Dick Bruna
Naam:
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Datum invulling:
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Algemene ontwikkelingsaspecten
Welke opvallende dingen / bijzonderheden kunt u noemen over:
Zwangerschap, geboorte, babytijd:
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Peutertijd:
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Ziektes / ongevallen / (eventuele) handicap / ziekenhuisopname / allergieën / medicijngebruik:
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Eten en drinken:
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Inslapen of slapen:
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Bijzondere gebeurtenissen in het gezin:
Verhuizing / scheiding / sterfgeval
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Zijn er bijzonderheden te melden vanuit het consultatiebureau?
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Heeft uw kind een peuterspeelzaal of kinderdagverblijf bezocht?
Ja / nee*
*Graag omcirkelen wat van toepassing is.
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Zijn er bijzonderheden te melden vanuit het kinderdagverblijf of peuterspeelzaal?
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Geeft u toestemming om informatie op te vragen bij het kinderdagverblijf en/of peuterspeelzaal?
Ja/Nee*
*Graag omcirkelen wat van toepassing is.
Ontwikkelingsgegevens
Kunt u iets vertellen over:
Zelfstandigheid en zelfredzaamheid:
Zelf aan- uitkleden / toiletbezoek / zindelijkheid / buitenspelen / initiatief nemen
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Sociaal- emotionele ontwikkeling:
Het karakter (temperament) van het kind bv. vriendelijk, gesloten, makkelijk, moeilijk, druk, rustig,
opvliegend. Omgang met andere kinderen en volwassenen / verwachting over aansluiting met
andere kinderen
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Spelontwikkeling:
Favoriete spelactiviteiten binnen en buiten / voorkeur voor speelgoed / voorkeur voor
speelkameraadjes
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Taalontwikkeling:
Welke thuistaal heeft het kind / dialect / kan het kind zich verstaanbaar maken / logopedie / komt er
dyslexie in de familie voor
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Grove motoriek:
Bewegen in de babytijd / kruipen / lopen / steppen / fietsen / aankleden
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Zintuiglijke ontwikkeling:
Ogen en gezichtsvermogen / oren en het gehoor
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Overige bijzonderheden die u als ouders en / of opvoeders belangrijk vindt voor het naar school gaan
van uw kind. Denk hierbij aan bijv. fysiotherapie / speciale begeleiding / speciale aanpak
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Zijn er zaken die u belangrijk vindt of waar u zich zorgen over maakt bij de start van uw kind op de
basisschool?
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Overige opmerkingen:
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Handtekening:
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