Dear Families-

We will be conducting our 2nd Home Visits (for a few new friends it will be the 1st
one) the week of January 4th-8th. During this home visit we will discuss your child’s
progress report and goals for the rest of the school year. Below I will list each day and
times we will be doing home visits. Please select 2-3 dates/times that could work for you
and list them in order of your 1st to last pick. We will try our best to use your first pick
but may have to choose one of your alternate dates. Please send this form back in as soon
as possible, so that we can let your know your home visit date before winter break.
Also, my baby is due the following week when preschool returns. We would like
to get all of the visits in before I go on maternity leave. If not, I will finish the visits in the
spring when I’m back.

Monday 1/4/10 Tuesday 1/5/10 Wednesday Thursday Friday 1/8/10

1/6/10 1/7/10
8:00am 8:00am 8:00am 8:00am 8:00am
8:30 am 8:30 am 8:30 am 8:30 am 8:30 am
9:00 am 9:00 am 9:00 am 9:00 am
9:30 am 9:30 am 9:30 am 9:30 am
10:00 am 10:00 am 10:00 am 10:00 am
10:30 am 10:30 am 10:30 am 10:30 am 11:30 am
11:00 am 11:00 am 11:00 am 11:00 am 12:00 pm
11:30 am 11:30 am 11:30 am 11:30 am 12:30 pm
1:00 pm 1:00 pm 1:00 pm 1:00 pm 1:00 pm
1:30 pm 1:30 pm 1:30 pm 1:30 pm 1:30 pm
2:00 pm 2:00 pm 2:00 pm 2:00 pm 2:00 pm
2:30 pm 2:30 pm 2:30 pm 2:30 pm 2:30 pm
3:00 pm 3:00 pm 3:00 pm 3:00 pm 3:00 pm
3:45 pm 3:45 pm 3:45 pm 3:45 pm 3:45 pm

Fill out bottom and return by the 15th.

1st Pick (date and time): _______________________

2nd Pick (date and time): _______________________

3rd Pick (date and time): ________________________

Child’s Name, Address and Phone Number: __________________________

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