Playgroup - Questionnaire - Childhood Cancer Association

Details

Parent's name

First name

Last name

Parent's email address

Child's name

First name

Last name

Child's date of birth

Date

What are you hoping your child will get from of attending this group?

What are you hoping to get from attending this playgroup?

Observations

What are your observations of your child’s current strengths?

Physical

Not at all

Sometimes

Most of the time

Always

Shows self-care skills (dressing, feeding)

Not at all

Sometimes

Most of the time

Always

Walks, runs, jumps, hops more smoothly

Not at all

Sometimes

Most of the time

Always

Enjoys rhythm and movement activities

Not at all

Sometimes

Most of the time

Always

Independently cuts paper with scissors

Not at all

Sometimes

Most of the time

Always

Imitates shapes when drawing (e.g. circles)

Not at all

Sometimes

Most of the time

Always

Social

Not at all

Sometimes

Most of the time

Always

Enjoys playing with other children

Not at all

Sometimes

Most of the time

Always

Shares, smiles and cooperates with peers

Not at all

Sometimes

Most of the time

Always

Emotional

Not at all

Sometimes

Most of the time

Always

Understands when someone is hurt and comforts them

Not at all

Sometimes

Most of the time

Always

Shows occasional bouts of aggression towards peers

Not at all

Sometimes

Most of the time

Always

Praises themself or boasts

Not at all

Sometimes

Most of the time

Always

Likes to give and receive affection from parents

Not at all

Sometimes

Most of the time

Always

Cognitive

Not at all

Sometimes

Most of the time

Always

Understands opposites (big/little) and positional words (middle/end)

Not at all

Sometimes

Most of the time

Always

Uses objects and materials to build and construct (towers, puzzles, sand)

Not at all

Sometimes

Most of the time

Always

Answers simple questions

Not at all

Sometimes

Most of the time

Always

Counts 5 to 10 things

Not at all

Sometimes

Most of the time

Always

Recounts a recent story

Not at all

Sometimes

Most of the time

Always

Language

Not at all

Sometimes

Most of the time

Always

Asks many questions

Not at all

Sometimes

Most of the time

Always

Speaks in sentences and uses many words

Not at all

Sometimes

Most of the time

Always

Tells stories

Not at all

Sometimes

Most of the time

Always

Takes part in conversation

Not at all

Sometimes

Most of the time

Always

Playgroup Questionnaire

What are your observations of your child’s current strengths?

Physical

Social

Emotional

Cognitive

Language

Please read each statement and select the option that best indicates how you are currently feeling.

Please read each statement about your child and select the option that best describes their behaviour.

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