Circle all mentioned.
IF YES, ASK: Who participated in this activity with (NAME)?
CIRCLE ALL MENTIONED.
IF YES, ASK: Who participated in this activity with (NAME)?
CIRCLE ALL MENTIONED.
a) Read books or looked at picture books with (NAME)?
b) Told stories to (NAME)?
c) Sung songs to (NAME) or with (NAME), including lullabies?
d) Taken (NAME) for a walk outside the house, of the dwelling, yard, or property?
e) Played with (NAME)?
f) Spent time naming, counting, and/or drawing with (NAME)?
a) Read books or looked at illustrated books with (name)?
b)Told stories to (name)?
c) Sang songs to (name), or with (name), including lullabies?
d) Took (name) for a walk outside of the house, the residence, the courtyard or the enclosure wall?
e) Played with (name)?
f) Spent time with (name), naming, counting, and/or drawing?
a) Read books or looked at illustrated books with (NAME)?
b) Told stories to (NAME)?
c) Sang songs to (NAME), or with (NAME), including lullabies?
d) Took (NAME) for a walk outside of the house, the residence, the courtyard or the enclosure wall?
e) Played with (NAME)?
f) Spent time with (NAME), naming, counting, and/or drawing?
a) Read books to or look at picture books with (NAME)
b) Told stories to (NAME)?
c) Sang songs to (NAME) or with (NAME), including lullabies?
d) Took (NAME) outside of the home, compound, yard or enclosure?
e) Played with (NAME)?
f) Named, counted, or drew things to or with (NAME)?
IF YES, ASK:
Who engaged in this activity with (NAME)?
RECORD ALL MENTIONED.
READING BOOKS OR LOOKING AT PICTURE BOOKS A
TELLING STORIES B
SINGING SONGS, INCLUDING NURSERY RHYMES C
GOING FOR WALKS D
PLAYING WITH HIM/HER E
SPENDING TIME COUNTING/DRAWING/NAMING OBJECTS F
OTHER (SPECIFY) _____ X
CIRCLE ALL MENTIONED.
CIRCLE ALL MENTIONED.