Kids Report Card

Kids Report Card
Date

MonthDayYear
Date
First Name
Dad's name:
Answer these questions the way you think your child would answer them.

By the end of the program it is our goal that your children would answer these questions in a positive way.

We understand these questions aren't always cut and dry, so please provide additional details in the fields below. Keep this information focused solely on the child(ren) and how you believe they would answer or what they experience.
My parents are on the same parenting team:

YesNo
Please provide additional details below:
My parents can count on each other for support:

YesNo
Please provide additional details below:
My parents talk about goals for me with each other:

YesNoI don't know
Please provide additional details below:
When my parents are in front of me, they speak in a positive and polite way:

YesNoI don't know
Please provide additional details below:
My parents discuss decisions about me successfully (i.e. school, doctors appointments, schedules):

YesNo
Please provide additional details below:
My parents can call or text each other, without hesitation, to talk about me:

YesNo
Please provide additional details below:
My parents have similar house rules and discipline in a positive way:

YesNo
Please provide additional details below:
My parents are careful not to talk with me about adult issues or things I cannot control:

YesNo
Please provide additional details below:
My parents keep me “out of the middle” by talking directly with each other:

YesNo
Please provide additional details below:
My parents encourage me to talk with my other parent directly when I have a problem:

YesNo
Please provide additional details below:
My parents help me feel comfortable living in two homes. I have everything I need:

YesNoI don't know
Please provide additional details below:
My parents can “agree to disagree”, for now, and solve the problem later when I am not around:

YesNoI don't know
Please provide additional details below:
My parents want to get along, but they haven't been able to figure out how:

YesNo
Please provide additional details below:
What would you say your children want more than anything in regards to their parents getting along?
Should be Empty: