Activate the Cat Life Story Log: Early Years
Date Information Collected
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Month
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Day
Year
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For the resident:
First Name
Last Name
Early Years Memories Of Family and Friends. My Grandparents:
Which Colour do They consider their Grandparents to be?
Please Select
Black
White
Red
Blue
Green
Yellow
Purple
Brown
A Subjective Evaluation would Be that ?
Please Select
They were Authoritarian Figures
That they Demanded Submission
That they were Freightaning
That they were Aloof
That they were Overpowering
That they were Very Important
That they were Not very important
Love played a big part.
Hate was an overiding factor
There were issues unresolved
Their feelings about them were neatral
They may have been abbusive
They were actually cruel
They were possibly uncaring
That they were very attentive
Give an idication as to how acurate you think this might be.
1
2
3
4
5
My Mother and Father:
Which Colour are their Mother and Father to be?
Please Select
Black
White
Red
Blue
Green
Yellow
Purple
Brown
A Subjective Evaluation would Be that ?
Please Select
They were Authoritarian Figures
That they Demanded Submission
That they were Freightaning
That they were Aloof
That they were Overpowering
That they were Very Important
That they were Not very important
Love played a big part.
Hate was an overiding factor
There were issues unresolved
Their feelings about them were neatral
They may have been abbusive
They were actually cruel
They were possibly uncaring
That they were very attentive
Give an idication as to how acurate you think this might be.
1
2
3
4
5
My Brothers and sisters were:
What colour do you consider your Brothers and sisters:
Please Select
Black
White
Red
Blue
Green
Yellow
Purple
Brown
A Subjective Evaluation would Be that ?
Please Select
They were Authoritarian Figures
That they Demanded Submission
That they were Freightaning
That they were Aloof
That they were Overpowering
That they were Very Important
That they were Not very important
Love played a big part.
Hate was an overiding factor
There were issues unresolved
Their feelings about them were neatral
They may have been abbusive
They were actually cruel
They were possibly uncaring
That they were very attentive
Give an idication as to how acurate you think this might be.
1
2
3
4
5
Other People such as Aunts and Uncles
Any Issues with these People
Talents and Intrests
Continuing Life Experiencies
Did The Talents continue Later in life?
Did the Interests Continue later in life?
Would you Like to take up Your Talents again?
Would you like to take up these intrests again?
Teachers and friends:
Any Issues with these People
Did any of these friends stay with you later in life:
My Achievements and Goals in Life.
Did You reach any of thse Goals
Yes
No
Partially
Funny or Unusual things that Happened to me
Was the transition from early chidhood to middle years an easy one?
Yes
No
Partially
Give an idication as to how acurate you think this might be.
1
2
3
4
5
Information collected by:
First Name
Last Name
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