Gaming Club Initial Parent Survey

Initial Parent Survey

Parent/Guardian Name *

First

Last

Child's Name *

First

Last

My child would rather be by themself than with other people. *

My child would rather play single player video games than multiplayer games. *

It’s easy for my child to make new friends. *

My child is able to understand how other people are feeling and knows how to react to their feelings. *

My child can easily tell when other people are joking or kidding with them. *

I feel that other kids are often mean to my child or bully my child. *

My child is good at working with others as part of a team to reach a goal or complete a project. *

My child has a hard time adjusting when other people are not doing things the way that they want them to. *

My child is open and receptive to other people when they give them directions or try to help them. *

I would like my child to have help in being able to make more friends. *

I would like my child to be able to better understand social cues from others. *

I would like my child to be better at working together with others as part of a team. *

What I am most looking forward to about this program is: *

Address: 2450 Summers Lane

Klamath Falls, OR 97603

Phone: (541) 887-2207

Fax: (541) 887-2208

Email: Info@tatertotstherapy.org