| Name
|
|
Joint
Family |
|
| Email
ID |
|
Mother
or Father |
|
1St
Child |
|
Age
of 1st Child |
|
| 2nd
Child |
|
Age
of 2nd Child |
|
| Profession
: |
|
Education
: |
|
| Spouse
Profession : |
|
Spouse’s
Education : |
|
| Your
& spouse Combined Monthly Gross Income ( Rs.):
|
|
| 1. Mark the level
of importance in the overall personality development of your
son/ daughter. |
| Memory
power |
|
Public
speaking |
|
| Listening
skills |
|
Group
discussion |
|
| Expertise
in one art |
|
Expertise
in one sport |
|
| Regular
exercise |
|
Reading
habits |
|
| Balanced
diet |
|
Self
confidence |
|
| 2. Which age period
is the most suitable for development of different personality
skills / traits? ..............................................
|
| 3. Who should initiate
FIRST to provide information on reproductive health care to
the adolescent boys and girls?.................
|
| 4. Did you discuss
the following subjects with your son/daughter, which may help
him/her during the development from child to adult? |
| Pubic
hair growth & removal |
|
Debate
& Group discussions |
|
| Pimple/Acne
care & treatment |
|
Child
sexual abuse |
|
| Gender
Friendship |
|
Daughter's
Menstruation care |
|
| Self
confidence |
|
Daughter
Breast development Bra |
|
| 5. Mention
your most preferred sources for additional help / information
if it is needed : (Book/Magazines, Internet, Teacher, Counselor,
doctor, Product promotion, TV, Advt. etc.) |
| Physical |
|
Social |
|
Emotional |
|
Intellectual |
|
|
|
