Summary Table of Fall Home Visit Questionnaire information

Special Family
Names of Favorite Favorite Favorite Important Dislikes Routines Routines or Additional
children Activities Stories & Foods & People or Fears Transitional Traditions Helpful
Songs Allergies Pets Objects Information
Soccer -Baby Shark N/A -Deb-day -The -Tickles -Normal Holidays N/A
Piano Leprechaun - Summit League
1.Logan -Llama Llama care -Hugs
Golf -Click Clack - sad if mom tournament
-Neighbors -Don’t give him
Pete works a lot
Baseball options.
- Pete, the cat Drew&Will
Snow
Riding bikes
-Where’s -cousins
Waldo

-Coloring -Thunder by - water only - Older sister Really Give her time! Normal Holidays If seizures are over
-Playing Imagine - no dairy - Family scared of Birthdays 5 min rectal
2. Kinsley outside Dragon - no soy - Dog Molly heights!!!!! valium
-Playing Babies -All Books -no peanuts -stools
and Doctor -chairs

-Coloring -Makes up -Watermelon -Cousins N/A Hugs Normal traditional Very Independent
- Run songs! -muskmelon -Chewy Christian holidays.
3.Micah -Superhero’s -cucumbers
-Bake - No food
Allergies
-Tries most
food

-Animal -This song is Fruits and Grandparents in N/A Don’t over Normal Holidays N/A
-Drama veggies! town. dramatize Christian
4. going to get
(pretend play) celebration
stuck in your
Jacey Mac n cheese Let her talk and
head.
calm down
-Llama Llama
Doesn’t like
- Makes up
meet Not a big hugger
her own
stories.
No Allergies
-Anything -The little -Donuts -Mom’s Doesn’t like -Verbalize 2 weeks with mom N/A
Outside people stories -Bannas and boyfriend Cole loud noises. emotions 1 week at dads
5. Hayde -Playing with (at grandma apples -Dad’s girlfriend Sensitive -Ask what he needs
Neighbors house) -Carrots Brittney hearing.
-Building -Dr. Seus -Pizza (expecting
-Art -Dinosaur No Food babies)
-Coloring Books allergies! -Grandma Mary
-Bella Chow -Neighbors
-John Mayer
-Legos -Imagine -Chocolate. -Grandparents -wasps - Might need some -Most traditional Shy to start.
-Reading Dragon -Pizza. -Cousins space. Christian
6.Tate -Star Wars -Green Holidays.
-Make stuff Apples - Halloween
- Soccer -Superhero’s - Green
-Swimming. Grapes
 Logan’s Home Visit Summary
Note the child's reaction to your visit.
(1) Logan was super outgoing and full of energy. He was very excited to show me his shoes
and toys. We played a game of air hockey and pretend play. He also showed me his room.
We had some fun conversations talking about him.
Describe the parents’ reaction to your visit.
(2) Logan’s parents were friendly and welcoming. They let Logan take the lead on the visit
and let him show me around. Once we played for a while, then his dad said to let her come
up so we can talk as a family. Logan was still very much involved in the adult
conversation. His parents were very open and supportive throughout the whole visit. They
made sure to let me know that they knew that Logan could be a handful sometimes and if
there were any behavioral issues that they would like to know about it so they can work on
it at home as well.
Describe observed parent-child interactions.
(3) Logan’s and his parent's interactions were very easy going. Logan's parents let him mostly
control how the visit went. If Logan's was unsure about something, he would ask his
parents for clarification.
What information have you gained from this visit that is helpful in understanding the child?
(4) Logan’s got a lot of energy. Loves sports and playing with friends. Loves playing with
neighbors.
How did you respond to this visit? What, if anything, would you do differently? What did you
learn about yourself as a teacher?
(5) Logan' s visit was fun because I was able to play with him and get to know him more. I
really enjoyed talking to his parents. They had a very clean house, and mom wasn't a fan of
animals inside the house. I probably could have talked to his parents more and gotten to
know them more, but playing with Logan took up a lot of the visit, and they had company
arriving that day, so there had to be a time limit.