Playgroup Questionnaire

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Playgroup
(for children aged 1-5 years)

Pre-Participation Questionnaire

33%
Details
Parent's name
Child's name
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) 
Walks, runs, jumps, hops more smoothly 
Enjoys rhythm and movement activities 
Independently cuts paper with scissors 
Imitates shapes when drawing (e.g. circles) 

Social

Not at all

Sometimes

Most of the time

Always

Enjoys playing with other children 
Shares, smiles and cooperates with peers 

Emotional

Not at all

Sometimes

Most of the time

Always

Understands when someone is hurt and comforts them 
Shows occasional bouts of aggression towards peers 
Praises themself or boasts 
Likes to give and receive affection from parents 

Cognitive

Not at all

Sometimes

Most of the time

Always

Understands opposites (big/little) and positional words (middle/end) 
Uses objects and materials to build and construct (towers, puzzles, sand) 
Answers simple questions 
Counts 5 to 10 things 
Recounts a recent story 

Language

Not at all

Sometimes

Most of the time

Always

Asks many questions 
Speaks in sentences and uses many words 
Tells stories 
Takes part in conversation 
Feelings & behaviour

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

There are no right or wrong answers. Do not spend too much time on any statement.

Not at all true

True some of the time

True a good part of the time

True all of the time

I am worried about my child missing out on attending early learning education opportunities due to a childhood cancer diagnosis in the family 
I am confident about my child meeting their regular developmental milestones despite not being able to attend regular playgroups/childcare 
I am confident my child will be ready to attend regular education settings once they are able (e.g. playgroup, preschool or school) 
I feel confident in my ability to develop my child’s school readiness skills at home 
I know what skills I should focus on teaching my child 
I know what types of activities I can do to develop my child’s knowledge and skills 

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

There are no right or wrong answers. Do not spend too much time on any statement.

Not at all true

True some of the time

True a good part of the time

True all of the time

My child separates easily from me 
My child gets frustrated and annoyed when trying to complete a task on their own 
My child copes well with change 
My child has a hard time controlling their emotions 
My child finds it difficult to wait their turn 
My child can follow simple instructions 

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