Who is included in your family?
What is your favorite time/activity with your child?
What is the best time of day for your family?
What is your family’s most challenging time of day?
What does your family like to do together?
What activities would your family like to participate in?
Who are the important people in your family’s life?
Where does your family usually spend time during the week?____________________________________________
Where does your family usually spend time on the weekends?
Is your family enrolled in PAT? __Y __ N Parent Educator:
Does your child attend child care? __ Y __ N
Attendance Days: M T W Th F Sa Su Hours:_____________________________________________
Caregiver : ___________________________________________ Location: ___________________________