{"id":3745,"date":"2020-08-05T12:31:03","date_gmt":"2020-08-05T16:31:03","guid":{"rendered":"https:\/\/youngmindsinmotion.com\/?page_id=3745"},"modified":"2020-08-15T19:01:50","modified_gmt":"2020-08-15T23:01:50","slug":"60-month-assessment","status":"publish","type":"page","link":"https:\/\/youngmindsinmotion.com\/es\/60-month-assessment\/","title":{"rendered":"Evaluaci\u00f3n de 60 meses"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3745\" class=\"elementor elementor-3745\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d5d7539 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d5d7539\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-c095873\" data-id=\"c095873\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-956ce50 elementor-widget elementor-widget-wp-widget-gform_widget\" data-id=\"956ce50\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wp-widget-gform_widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='gforms_reset_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/formreset.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_datepicker_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/datepicker.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_formsmain_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/formsmain.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_ready_class_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/readyclass.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<link rel='stylesheet' id='gforms_browsers_css-css' href='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/legacy\/css\/browsers.min.css?ver=2.9.31' type='text\/css' media='all' \/>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/dom-ready.min.js?ver=f77871ff7694fffea381\" id=\"wp-dom-ready-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/hooks.min.js?ver=4d63a3d491d11ffd8ac6\" id=\"wp-hooks-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/dist\/i18n.min.js?ver=5e580eb46a90c2b997e6\" id=\"wp-i18n-js\"><\/script>\n<script type=\"text\/javascript\" id=\"wp-i18n-js-after\">\n\/* <![CDATA[ *\/\nwp.i18n.setLocaleData( { 'text direction\\u0004ltr': [ 'ltr' ] } );\n\/* ]]> *\/\n<\/script>\n<script type=\"text\/javascript\" id=\"wp-a11y-js-translations\">\n\/* <![CDATA[ *\/\n( function( domain, translations ) {\n\tvar localeData = translations.locale_data[ domain ] || translations.locale_data.messages;\n\tlocaleData[\"\"].domain = domain;\n\twp.i18n.setLocaleData( localeData, domain );\n} )( \"default\", {\"translation-revision-date\":\"2026-03-27 23:59:20+0000\",\"generator\":\"GlotPress\\\/4.0.3\",\"domain\":\"messages\",\"locale_data\":{\"messages\":{\"\":{\"domain\":\"messages\",\"plural-forms\":\"nplurals=2; 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El contenido incluye el enlace para volver y completar el formulario.\"}};\n\/* ]]> *\/\n<\/script>\n<script type=\"text\/javascript\" defer='defer' src=\"https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/js\/gravityforms.min.js?ver=2.9.31\" id=\"gform_gravityforms-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/jquery\/ui\/core.min.js?ver=1.13.3\" id=\"jquery-ui-core-js\"><\/script>\n<script type=\"text\/javascript\" src=\"https:\/\/youngmindsinmotion.com\/wp-includes\/js\/jquery\/ui\/datepicker.min.js?ver=1.13.3\" id=\"jquery-ui-datepicker-js\"><\/script>\n<script type=\"text\/javascript\" defer='defer' src=\"https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/js\/datepicker-legacy.min.js?ver=2.9.31\" id=\"gform_datepicker_legacy-js\"><\/script>\n<script type=\"text\/javascript\" defer='defer' src=\"https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/js\/datepicker.min.js?ver=2.9.31\" id=\"gform_datepicker_init-js\"><\/script>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_18' ><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/es\/wp-json\/wp\/v2\/pages\/3745' data-formid='18' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_18_1\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2016\/09\/YMIM-logo-2.png\" width=\"247\" height=\"90\" \/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\">\n<h2 style=\"text-align:center;\">PARENT QUESTIONNAIRE\n<\/h2>\n<\/li><li id=\"field_18_2\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"p1\"><span class=\"s1\">Dear Parents,<\/span><\/p>\n<p class=\"p3\"><span class=\"s1\">Please help us get to know your child <\/span><span class=\"s2\">by <\/span><span class=\"s1\">filling out this form. <\/span><span class=\"s3\">All <\/span><span class=\"s1\">the information will be confidential. We <\/span><span class=\"s3\">will <\/span><span class=\"s1\">use what you tell us as we begin to get to know your child and <\/span><span class=\"s4\">p<\/span><span class=\"s5\">l<\/span><span class=\"s3\">a<\/span><span class=\"s1\">n<\/span> <span class=\"s3\">wa<\/span><span class=\"s6\">y<\/span><span class=\"s1\">s<\/span> <span class=\"s3\">t<\/span><span class=\"s1\">o<\/span> <span class=\"s7\">m<\/span><span class=\"s1\">eet<\/span><span class=\"s3\"> hi<\/span><span class=\"s1\">s<\/span><span class=\"s3\">\/<\/span><span class=\"s4\">h<\/span><span class=\"s1\">er<\/span> <span class=\"s3\">n<\/span><span class=\"s2\">e<\/span><span class=\"s1\">e<\/span><span class=\"s6\">d<\/span><span class=\"s1\">s<\/span><span class=\"s3\"> and t<\/span><span class=\"s1\">o <\/span><span class=\"s3\">h<\/span><span class=\"s2\">e<\/span><span class=\"s6\">l<\/span><span class=\"s1\">p<\/span> <span class=\"s3\">h<\/span><span class=\"s4\">i<\/span><span class=\"s5\">m<\/span><span class=\"s3\">\/h<\/span><span class=\"s1\">er develop.<\/span> <span class=\"s1\">Please<\/span> <span class=\"s1\">return<\/span> <span class=\"s1\">it<\/span> <span class=\"s1\">to<\/span> <span class=\"s1\">school<\/span> <span class=\"s1\">as<\/span> <span class=\"s1\">soon<\/span> <span class=\"s1\">as<\/span> <span class=\"s1\">possible.<\/span><\/p>\n<p class=\"p5\"><span class=\"s1\">Thanks so much!<\/span><\/p><\/li><li id=\"field_18_3\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_3'>Child&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_18_3' type='text' value='' class='medium'   tabindex='1'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_4\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_4'>Child&#039;s Nickname<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_18_4' type='text' value='' class='medium'   tabindex='2'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_5\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_5'>Parents\u2019 Names<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_18_5' type='text' value='' class='medium'   tabindex='3'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_6\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_6'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_6' id='input_18_6' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='4'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_18_6_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_18_6_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_18_6' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_18_7\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_7'>Child\u2019s Teacher<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_18_7' type='text' value='' class='medium'   tabindex='5'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_8\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Does your child live with?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_8'><li class='gchoice gchoice_18_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Both Parents'  id='choice_18_8_1' tabindex='6'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_8_1' id='label_18_8_1' class='gform-field-label gform-field-label--type-inline'>Both Parents<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='One Parent'  id='choice_18_8_2' tabindex='7'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_8_2' id='label_18_8_2' class='gform-field-label gform-field-label--type-inline'>One Parent<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Other adults'  id='choice_18_8_3' tabindex='8'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_8_3' id='label_18_8_3' class='gform-field-label gform-field-label--type-inline'>Other adults<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_9\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_9'>Please Specify<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_18_9' class='textarea medium' tabindex='9'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_10\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_10'>Please list the names and ages of others who live in your home. (This will help me write names correctly on pictures your child draws about his\/her family.)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_18_10' class='textarea medium' tabindex='10'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_11\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_11'>Pets (Name &amp; type of animal)<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_18_11' type='text' value='' class='medium'   tabindex='11'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_12\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_12'>Father\u2019s Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_18_12' type='text' value='' class='medium'   tabindex='12'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_13\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_13'>Mother&#039;s Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_18_13' type='text' value='' class='medium'   tabindex='13'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_14\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Does your child have a room of his own?<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_14'><li class='gchoice gchoice_18_14_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.1' type='checkbox'  value='Yes'  id='choice_18_14_1' tabindex='14'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_14_1' id='label_18_14_1' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_14_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_14.2' type='checkbox'  value='No'  id='choice_18_14_2' tabindex='15'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_14_2' id='label_18_14_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_15\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_15'>If not, with whom does he\/she share a room?<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_18_15' type='text' value='' class='medium'   tabindex='16'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_16\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_16'>What are your child\u2019s favourite play activities and interests?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_18_16' class='textarea medium' tabindex='17'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_17\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_17'>Does child use special words to go to the bathroom?<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_18_17' type='text' value='' class='medium'   tabindex='18'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_18\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_18'>Child\u2019s favorite TV programs<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_18_18' class='textarea medium' tabindex='19'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_19\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_19'>Hours per day spent watching TV<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_18_19' type='text' value='' class='medium'   tabindex='20'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_20\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Does your child usually play<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_20'><li class='gchoice gchoice_18_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Alone?'  id='choice_18_20_1' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_1' id='label_18_20_1' class='gform-field-label gform-field-label--type-inline'>Alone?<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='With a friend?'  id='choice_18_20_2' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_2' id='label_18_20_2' class='gform-field-label gform-field-label--type-inline'>With a friend?<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_20_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.3' type='checkbox'  value='With a few friend?'  id='choice_18_20_3' tabindex='23'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_3' id='label_18_20_3' class='gform-field-label gform-field-label--type-inline'>With a few friend?<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_20_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.4' type='checkbox'  value='with younger children?'  id='choice_18_20_4' tabindex='24'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_4' id='label_18_20_4' class='gform-field-label gform-field-label--type-inline'>with younger children?<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_20_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.5' type='checkbox'  value='with older children?'  id='choice_18_20_5' tabindex='25'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_5' id='label_18_20_5' class='gform-field-label gform-field-label--type-inline'>with older children?<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_18_20_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.6' type='checkbox'  value='with children the same age?'  id='choice_18_20_6' tabindex='26'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_18_20_6' id='label_18_20_6' class='gform-field-label gform-field-label--type-inline'>with children the same age?<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_21\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_21'>Does child have decided fears?   If so, what?<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_18_21' type='text' value='' class='medium'   tabindex='27'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_22\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_22'>What responsibilities does your child have at home?<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_18_22' type='text' value='' class='medium'   tabindex='28'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_24\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_24'>What is your biggest discipline problem?<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_18_24' type='text' value='' class='medium'   tabindex='29'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_159\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_159'>How do you discipline your child?<\/label><div class='ginput_container ginput_container_text'><input name='input_159' id='input_18_159' type='text' value='' class='medium'   tabindex='30'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_25\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_25'>What is your child\u2019s favorite story or type of story or book?<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_18_25' type='text' value='' class='medium'   tabindex='31'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_26\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_26'>Did your child have a premature or difficult birth that may indicate cognitive delays?<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_18_26' type='text' value='' class='medium'   tabindex='32'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_160\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_160'>Is English your child\u2019s first language? If not, what is?<\/label><div class='ginput_container ginput_container_text'><input name='input_160' id='input_18_160' type='text' value='' class='medium'   tabindex='33'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_27\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_27'>Is English the primary language spoken in the home?   If not, what is?<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_18_27' type='text' value='' class='medium'   tabindex='34'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_28\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_28'>Does your child speak any English? \tUnderstand English?<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_18_28' type='text' value='' class='medium'   tabindex='35'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_29\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_29'>How does your child feel about coming to school?<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_18_29' type='text' value='' class='medium'   tabindex='36'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_30\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_30'>What do you hope your child will learn this year?<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_18_30' type='text' value='' class='medium'   tabindex='37'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_31\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_31'>What is the most important thing I should know about your child?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_18_31' class='textarea medium' tabindex='38'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_32\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"p1\"><span class=\"s1\">It is our goal to encourage a sense of belongingness, promote an appreciation of others and enrich children\u2019s experiences by integrating into our curriculum activities and information that reflect our individual children\u2019s background.<span class=\"Apple-converted-space\">\u00a0 <\/span>One way we can do this is by learning about each child\u2019s family background, celebrated holidays, and traditions. Please take a few minutes to share with us your special family days or activities and how they are carried out in your home.<\/span><\/p><\/li><li id=\"field_18_33\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_33'>What languages other than English are spoken by family members around your child?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_33' id='input_18_33' class='textarea medium' tabindex='39'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_34\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_34'>Does your child have any physical or learning disabilities? \tIf so, please describe<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_18_34' class='textarea medium' tabindex='40'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_35\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_35'>Are there any family members with disabilities that may directly impact your child\u2019s daily life (for example, a deaf grandparent, wheelchair bound parent, etc.)?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_35' id='input_18_35' class='textarea medium' tabindex='41'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_36\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_36'>What information about your family\u2019s background and culture would you like to share with us?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_36' id='input_18_36' class='textarea medium' tabindex='42'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_37\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_37'>What are the holidays, special days, or traditions your family partakes in?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_18_37' class='textarea medium' tabindex='43'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_38\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_38'>Are there any special foods, songs, items or symbols you include in your celebration of special family times?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_38' id='input_18_38' class='textarea medium' tabindex='44'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_39\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_39'>Does your child have any dietary restrictions due to allergies, intolerances, family or religious preferences? \tIf yes, what is restricted?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_39' id='input_18_39' class='textarea medium' tabindex='45'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_40\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_40'>Are there any activities from your family\u2019s culture or traditions that you would like to share with your child\u2019s classroom?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_40' id='input_18_40' class='textarea medium' tabindex='46'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_42\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_42'>Please make comments about anything else you think I need to know about your child<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_42' id='input_18_42' class='textarea medium' tabindex='47'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_43\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_43'>What are their strengths?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_18_43' class='textarea medium' tabindex='48'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_44\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_44'>What are the areas of weakness? What would you love for your child to get better at?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_44' id='input_18_44' class='textarea medium' tabindex='49'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_45\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_45'>My child learns best when the teacher is\u2026.<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_18_45' type='text' value='' class='medium'   tabindex='50'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_46\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_46'>My child does not work well with\u2026<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_18_46' type='text' value='' class='medium'   tabindex='51'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_47\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_47'>What is the best way to motivate your child?<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_18_47' type='text' value='' class='medium'   tabindex='52'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_48\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_48'>What are you looking forward to at YMIM?<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_18_48' type='text' value='' class='medium'   tabindex='53'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_49\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_49'>How would you like to be involved with your child\u2019s education?<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_18_49' type='text' value='' class='medium'   tabindex='54'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_50\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_50'>What is your preferred method of communication (email, phone call, meeting, note\u2026)<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_18_50' type='text' value='' class='medium'   tabindex='55'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_51\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-9.40.59-PM.png\"\/ style=\"width:430px; height:150px; margin-top:50px;\"><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-9.44.15-PM.png\"\/ float:right;\"><\/li><li id=\"field_18_161\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_161'>Child\u2019s date of birth:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_161' id='input_18_161' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='56'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_18_161_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_18_161_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_18_161' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_18_162\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Is It a Boy Or a Girl?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_162'>\n\t\t\t<li class='gchoice gchoice_18_162_0'>\n\t\t\t\t<input name='input_162' type='radio' value='Boy'  id='choice_18_162_0' tabindex='57'   \/>\n\t\t\t\t<label for='choice_18_162_0' id='label_18_162_0' class='gform-field-label gform-field-label--type-inline'>Boy<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_162_1'>\n\t\t\t\t<input name='input_162' type='radio' value='Girl'  id='choice_18_162_1' tabindex='58'   \/>\n\t\t\t\t<label for='choice_18_162_1' id='label_18_162_1' class='gform-field-label gform-field-label--type-inline'>Girl<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_163\" class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_163'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_163' id='input_18_163' type='email' value='' class='medium' tabindex='59'    aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_18_55\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_55'>Date ASQ-3 completed by parent\/caregiver:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_55' id='input_18_55' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='60'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_18_55_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_18_55_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_18_55' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_18_54\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_54'>Date of review with health professional:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_54' id='input_18_54' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='61'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_18_54_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_18_54_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_18_54' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_18_56\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_56'>Child\u2019s home address<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_18_56' type='text' value='' class='medium'   tabindex='62'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_57\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_57'>Town<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_18_57' type='text' value='' class='medium'   tabindex='63'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_58\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_58'>Postcode<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_18_58' type='text' value='' class='medium'   tabindex='64'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_59\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_59'>Person completing the questionnaire<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_18_59' type='text' value='' class='medium'   tabindex='65'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_60\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_60'>Relationship to child:<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_18_60' type='text' value='' class='medium'   tabindex='66'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_61\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_61'>Home tel:<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_18_61' type='text' value='' class='medium'   tabindex='67'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_62\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_62'>Mobile no. :<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_18_62' type='text' value='' class='medium'   tabindex='68'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_63\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p class=\"p1\">All children develop at different rates and in different ways. Please do not worry if your child is not doing all or any of the activities mentioned in the questionnaire. It is not a test. The activities are simply one way of understanding how your child is progressing<\/p>\n\n<p class=\"p1\">Possible answers:<\/p>\n<p class=\"p1\">Yes = your child does this activity (or has done it and has now progressed, e.g., crawling, but is now walking)<\/p>\n<p class=\"p1\">Sometimes = your child is just beginning to do this activity (but does not do it regularly)<\/p>\n<p class=\"p1\">Not Yet = your child has not yet started doing this <\/p>\n<p class=\"p1\">Please leave blank any activities your child has not been able to try with you<\/p><\/li><li id=\"field_18_64\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-10.00.47-PM.png\"\/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\"><\/li><li id=\"field_18_65\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Important Points to Remember:<\/h2>\n<ul>\n    <li>Try each activity with your child before marking a response.<\/li>\n<li>Make completing this questionnaire a game that is fun for you and your child.<\/li>\n<li>Make sure your child is not tired or hungry.<\/li>\n<li>Please bring this questionnaire with you to your child\u2019s health and development review.<\/li><\/li><li id=\"field_18_67\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_67'>Additional Notes<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_18_67' class='textarea medium' tabindex='69'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_68\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Communication<\/h3><\/li><li id=\"field_18_139\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Without giving help by pointing or repeating directions, does your child follow three directions that are unrelated to one another? Give all three directions before your child starts. For example, you may ask your child, \u201cClap your hands, walk to the door, and sit down,\u201d or \u201cGive me the pen, open the book, and stand up.\u201d<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_139'>\n\t\t\t<li class='gchoice gchoice_18_139_0'>\n\t\t\t\t<input name='input_139' type='radio' value='Yes'  id='choice_18_139_0' tabindex='70'   \/>\n\t\t\t\t<label for='choice_18_139_0' id='label_18_139_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_139_1'>\n\t\t\t\t<input name='input_139' type='radio' value='Sometimes'  id='choice_18_139_1' tabindex='71'   \/>\n\t\t\t\t<label for='choice_18_139_1' id='label_18_139_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_139_2'>\n\t\t\t\t<input name='input_139' type='radio' value='Not Yet'  id='choice_18_139_2' tabindex='72'   \/>\n\t\t\t\t<label for='choice_18_139_2' id='label_18_139_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_69\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child use four- and five-word sentences? For example, does your child say, \u201cI want the car\u201d?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_69'>\n\t\t\t<li class='gchoice gchoice_18_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Yes'  id='choice_18_69_0' tabindex='73'   \/>\n\t\t\t\t<label for='choice_18_69_0' id='label_18_69_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='Sometimes'  id='choice_18_69_1' tabindex='74'   \/>\n\t\t\t\t<label for='choice_18_69_1' id='label_18_69_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='Not Yet'  id='choice_18_69_2' tabindex='75'   \/>\n\t\t\t\t<label for='choice_18_69_2' id='label_18_69_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_154\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_154'>Please write an example:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_154' id='input_18_154' class='textarea medium' tabindex='76'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_70\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >When talking about something that already happened, does your child use words that end in \u201c-ed,\u201d such as \u201cwalked,\u201d \u201cjumped,\u201d or \u201cplayed\u201d? Ask your child questions, such as \u201cHow did you get to the store?\u201d (\u201cWe walked.\u201d) \u201cWhat did you do at your friend\u2019s house?\u201d (\u201cWe played.\u201d)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_70'>\n\t\t\t<li class='gchoice gchoice_18_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='Yes'  id='choice_18_70_0' tabindex='77'   \/>\n\t\t\t\t<label for='choice_18_70_0' id='label_18_70_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='Sometimes'  id='choice_18_70_1' tabindex='78'   \/>\n\t\t\t\t<label for='choice_18_70_1' id='label_18_70_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_70_2'>\n\t\t\t\t<input name='input_70' type='radio' value='Not Yet'  id='choice_18_70_2' tabindex='79'   \/>\n\t\t\t\t<label for='choice_18_70_2' id='label_18_70_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_155\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_155'>Please write an example:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_155' id='input_18_155' class='textarea medium' tabindex='80'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_72\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child use comparison words, such as \u201cheavier,\u201d \u201cstronger,\u201d or \u201cshorter\u201d? Ask your child questions, such as \u201cA car is big, but a bus is \t\u201d (bigger); \u201cA cat is heavy, but a man is \t\u201d (heavier); \u201cA TV is small, but a book is \t\u201d (smaller).<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_72'>\n\t\t\t<li class='gchoice gchoice_18_72_0'>\n\t\t\t\t<input name='input_72' type='radio' value='Yes'  id='choice_18_72_0' tabindex='81'   \/>\n\t\t\t\t<label for='choice_18_72_0' id='label_18_72_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_72_1'>\n\t\t\t\t<input name='input_72' type='radio' value='Sometimes'  id='choice_18_72_1' tabindex='82'   \/>\n\t\t\t\t<label for='choice_18_72_1' id='label_18_72_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_72_2'>\n\t\t\t\t<input name='input_72' type='radio' value='Not Yet'  id='choice_18_72_2' tabindex='83'   \/>\n\t\t\t\t<label for='choice_18_72_2' id='label_18_72_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_156\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_156'>Please write an example:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_156' id='input_18_156' class='textarea medium' tabindex='84'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_71\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child answer the following questions? (Mark \u201csometimes\u201d if your child answers only one question.) \u201cWhat do you do when you are hungry?\u201d (Acceptable answers include \u201cget food,\u201d \u201ceat,\u201d \u201cask for something to eat,\u201d and \u201chave a snack.\u201d) \u201cWhat do you do when you are tired?\u201d (Acceptable answers include: \u201ctake a nap,\u201d \u201crest,\u201d \u201cgo to sleep,\u201d \u201cgo to bed,\u201d \u201clie down,\u201d and \u201csit down.\u201d) Please write your child\u2019s response:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_71'>\n\t\t\t<li class='gchoice gchoice_18_71_0'>\n\t\t\t\t<input name='input_71' type='radio' value='Yes'  id='choice_18_71_0' tabindex='85'   \/>\n\t\t\t\t<label for='choice_18_71_0' id='label_18_71_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_71_1'>\n\t\t\t\t<input name='input_71' type='radio' value='Sometimes'  id='choice_18_71_1' tabindex='86'   \/>\n\t\t\t\t<label for='choice_18_71_1' id='label_18_71_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_71_2'>\n\t\t\t\t<input name='input_71' type='radio' value='Not Yet'  id='choice_18_71_2' tabindex='87'   \/>\n\t\t\t\t<label for='choice_18_71_2' id='label_18_71_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_157\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_157'>Please write an example:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_157' id='input_18_157' class='textarea medium' tabindex='88'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_73\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child repeat the sentences shown below back to you, with- out any mistakes? (Read the sentences one at a time. You may repeat each sentence one time. Mark \u201cyes\u201d if your child repeats both sen- tences without mistakes or \u201csometimes\u201d if your child repeats one sen- tence without mistakes.) Jane hides her shoes for Maria to find. Al read the blue book under his bed.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_73'>\n\t\t\t<li class='gchoice gchoice_18_73_0'>\n\t\t\t\t<input name='input_73' type='radio' value='Yes'  id='choice_18_73_0' tabindex='89'   \/>\n\t\t\t\t<label for='choice_18_73_0' id='label_18_73_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_73_1'>\n\t\t\t\t<input name='input_73' type='radio' value='Sometimes'  id='choice_18_73_1' tabindex='90'   \/>\n\t\t\t\t<label for='choice_18_73_1' id='label_18_73_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_73_2'>\n\t\t\t\t<input name='input_73' type='radio' value='Not Yet'  id='choice_18_73_2' tabindex='91'   \/>\n\t\t\t\t<label for='choice_18_73_2' id='label_18_73_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_76\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_76'>Communication Total<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_18_76' type='text' value='' class='medium'   tabindex='92'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_77\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>GROSS MOTOR<\/h3><\/li><li id=\"field_18_78\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >While standing, does your child throw a ball overhand in the direction of a person standing at least 6 feet away? To throw overhand, your child must raise his arm to shoulder height and throw the ball forward. (Dropping the ball or throwing the ball underhand should be scored as \u201cnot yet.\u201d)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_78'>\n\t\t\t<li class='gchoice gchoice_18_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='Yes'  id='choice_18_78_0' tabindex='93'   \/>\n\t\t\t\t<label for='choice_18_78_0' id='label_18_78_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='Sometimes'  id='choice_18_78_1' tabindex='94'   \/>\n\t\t\t\t<label for='choice_18_78_1' id='label_18_78_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_78_2'>\n\t\t\t\t<input name='input_78' type='radio' value='Not Yet'  id='choice_18_78_2' tabindex='95'   \/>\n\t\t\t\t<label for='choice_18_78_2' id='label_18_78_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_81\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-6.36.06-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_18_79\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child catch a large ball with both hands? (You should stand about 5 feet away and give your child two or three tries before you mark the answer.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_79'>\n\t\t\t<li class='gchoice gchoice_18_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='Yes'  id='choice_18_79_0' tabindex='96'   \/>\n\t\t\t\t<label for='choice_18_79_0' id='label_18_79_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='Sometimes'  id='choice_18_79_1' tabindex='97'   \/>\n\t\t\t\t<label for='choice_18_79_1' id='label_18_79_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_79_2'>\n\t\t\t\t<input name='input_79' type='radio' value='Not Yet'  id='choice_18_79_2' tabindex='98'   \/>\n\t\t\t\t<label for='choice_18_79_2' id='label_18_79_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_140\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-8.17.32-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_18_148\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Without holding onto anything, does your child stand on one foot for at least 5 seconds without losing her balance and putting her foot down? (You may give your child two or three tries before you mark the answer.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_148'>\n\t\t\t<li class='gchoice gchoice_18_148_0'>\n\t\t\t\t<input name='input_148' type='radio' value='Yes'  id='choice_18_148_0' tabindex='99'   \/>\n\t\t\t\t<label for='choice_18_148_0' id='label_18_148_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_148_1'>\n\t\t\t\t<input name='input_148' type='radio' value='Sometimes'  id='choice_18_148_1' tabindex='100'   \/>\n\t\t\t\t<label for='choice_18_148_1' id='label_18_148_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_148_2'>\n\t\t\t\t<input name='input_148' type='radio' value='Not Yet'  id='choice_18_148_2' tabindex='101'   \/>\n\t\t\t\t<label for='choice_18_148_2' id='label_18_148_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_149\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-5.02.30-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_18_82\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child walk on his tiptoes for 15 feet (about the length of a large car)? (You may show him how to do this.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_82'>\n\t\t\t<li class='gchoice gchoice_18_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Yes'  id='choice_18_82_0' tabindex='102'   \/>\n\t\t\t\t<label for='choice_18_82_0' id='label_18_82_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='Sometimes'  id='choice_18_82_1' tabindex='103'   \/>\n\t\t\t\t<label for='choice_18_82_1' id='label_18_82_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_82_2'>\n\t\t\t\t<input name='input_82' type='radio' value='Not Yet'  id='choice_18_82_2' tabindex='104'   \/>\n\t\t\t\t<label for='choice_18_82_2' id='label_18_82_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_84\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child hop forward on one foot for a distance of 4\u20136 feet without putting down the other foot? (You may give her two tries on each foot. Mark \u201csometimes\u201d if she can hop on one foot only.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_84'>\n\t\t\t<li class='gchoice gchoice_18_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='Yes'  id='choice_18_84_0' tabindex='105'   \/>\n\t\t\t\t<label for='choice_18_84_0' id='label_18_84_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='Sometimes'  id='choice_18_84_1' tabindex='106'   \/>\n\t\t\t\t<label for='choice_18_84_1' id='label_18_84_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_84_2'>\n\t\t\t\t<input name='input_84' type='radio' value='Not Yet'  id='choice_18_84_2' tabindex='107'   \/>\n\t\t\t\t<label for='choice_18_84_2' id='label_18_84_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_86\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child skip using alternating feet? (You may show him how to do this.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_86'>\n\t\t\t<li class='gchoice gchoice_18_86_0'>\n\t\t\t\t<input name='input_86' type='radio' value='Yes'  id='choice_18_86_0' tabindex='108'   \/>\n\t\t\t\t<label for='choice_18_86_0' id='label_18_86_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_86_1'>\n\t\t\t\t<input name='input_86' type='radio' value='Sometimes'  id='choice_18_86_1' tabindex='109'   \/>\n\t\t\t\t<label for='choice_18_86_1' id='label_18_86_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_86_2'>\n\t\t\t\t<input name='input_86' type='radio' value='Not Yet'  id='choice_18_86_2' tabindex='110'   \/>\n\t\t\t\t<label for='choice_18_86_2' id='label_18_86_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_90\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_90'>GROSS MOTOR TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_18_90' type='text' value='' class='medium'   tabindex='111'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_91\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>FINE MOTOR<\/h3><\/li><li id=\"field_18_92\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Ask your child to trace on the line below with a pencil. Does your child trace on the line without going off the line more than two times? (Mark \u201csometimes\u201d if your child goes off the line three times.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_92'>\n\t\t\t<li class='gchoice gchoice_18_92_0'>\n\t\t\t\t<input name='input_92' type='radio' value='Yes'  id='choice_18_92_0' tabindex='112'   \/>\n\t\t\t\t<label for='choice_18_92_0' id='label_18_92_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_92_1'>\n\t\t\t\t<input name='input_92' type='radio' value='Sometimes'  id='choice_18_92_1' tabindex='113'   \/>\n\t\t\t\t<label for='choice_18_92_1' id='label_18_92_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_92_2'>\n\t\t\t\t<input name='input_92' type='radio' value='Not Yet'  id='choice_18_92_2' tabindex='114'   \/>\n\t\t\t\t<label for='choice_18_92_2' id='label_18_92_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_141\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-10.40.31-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_18_93\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Ask your child to draw a picture of a person on a blank sheet of paper. You may ask your child, \u201cDraw a picture of a girl or a boy.\u201d If your child draws a person with head, body, arms, and legs, mark \u201cyes.\u201d If your child draws a person with only three parts (head, body, arms, or legs), mark \u201csometimes.\u201d If your child draws a person with two or fewer parts (head, body, arms, or legs), mark \u201cnot yet.\u201d Be sure to include the sheet of paper with your child\u2019s drawing with this questionnaire<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_93'>\n\t\t\t<li class='gchoice gchoice_18_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='Yes'  id='choice_18_93_0' tabindex='115'   \/>\n\t\t\t\t<label for='choice_18_93_0' id='label_18_93_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='Sometimes'  id='choice_18_93_1' tabindex='116'   \/>\n\t\t\t\t<label for='choice_18_93_1' id='label_18_93_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_93_2'>\n\t\t\t\t<input name='input_93' type='radio' value='Not Yet'  id='choice_18_93_2' tabindex='117'   \/>\n\t\t\t\t<label for='choice_18_93_2' id='label_18_93_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_94\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Draw a line across a piece of paper. Using child-safe scissors, does your child cut the paper in half on a more or less straight line, making the blades go up and down? (Carefully watch your child\u2019s use of scissors for safety reasons.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_94'>\n\t\t\t<li class='gchoice gchoice_18_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value='Yes'  id='choice_18_94_0' tabindex='118'   \/>\n\t\t\t\t<label for='choice_18_94_0' id='label_18_94_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='Sometimes'  id='choice_18_94_1' tabindex='119'   \/>\n\t\t\t\t<label for='choice_18_94_1' id='label_18_94_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_94_2'>\n\t\t\t\t<input name='input_94' type='radio' value='Not Yet'  id='choice_18_94_2' tabindex='120'   \/>\n\t\t\t\t<label for='choice_18_94_2' id='label_18_94_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_142\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-6.43.52-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_18_95\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Using the shapes below to look at, does your child copy the shapes in the space below without tracing? (Your child\u2019s drawings should look similar to the design of the shapes below, but they may be different in size. Mark \u201cyes\u201d if she copies all three shapes; mark \u201csometimes\u201d if your child copies two shapes.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_95'>\n\t\t\t<li class='gchoice gchoice_18_95_0'>\n\t\t\t\t<input name='input_95' type='radio' value='Yes'  id='choice_18_95_0' tabindex='121'   \/>\n\t\t\t\t<label for='choice_18_95_0' id='label_18_95_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_95_1'>\n\t\t\t\t<input name='input_95' type='radio' value='Sometimes'  id='choice_18_95_1' tabindex='122'   \/>\n\t\t\t\t<label for='choice_18_95_1' id='label_18_95_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_95_2'>\n\t\t\t\t<input name='input_95' type='radio' value='Not Yet'  id='choice_18_95_2' tabindex='123'   \/>\n\t\t\t\t<label for='choice_18_95_2' id='label_18_95_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_143\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-10.49.34-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_18_96\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Using the letters below to look at, does your child copy the letters without tracing? Cover up all of the letters except the letter being copied. (Mark \u201cyes\u201d if your child copies four of the letters and you can read them. Mark \u201csometimes\u201d if your child copies two or three letters and you can read them.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_96'>\n\t\t\t<li class='gchoice gchoice_18_96_0'>\n\t\t\t\t<input name='input_96' type='radio' value='Yes'  id='choice_18_96_0' tabindex='124'   \/>\n\t\t\t\t<label for='choice_18_96_0' id='label_18_96_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_96_1'>\n\t\t\t\t<input name='input_96' type='radio' value='Sometimes'  id='choice_18_96_1' tabindex='125'   \/>\n\t\t\t\t<label for='choice_18_96_1' id='label_18_96_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_96_2'>\n\t\t\t\t<input name='input_96' type='radio' value='Not Yet'  id='choice_18_96_2' tabindex='126'   \/>\n\t\t\t\t<label for='choice_18_96_2' id='label_18_96_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_158\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-10.51.31-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_18_97\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Print your child\u2019s first name. Can your child copy the letters? The letters may be large, backward, or reversed. (Mark \u201csometimes\u201d if your child copies about half of the letters.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_97'>\n\t\t\t<li class='gchoice gchoice_18_97_0'>\n\t\t\t\t<input name='input_97' type='radio' value='Yes'  id='choice_18_97_0' tabindex='127'   \/>\n\t\t\t\t<label for='choice_18_97_0' id='label_18_97_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_97_1'>\n\t\t\t\t<input name='input_97' type='radio' value='Sometimes'  id='choice_18_97_1' tabindex='128'   \/>\n\t\t\t\t<label for='choice_18_97_1' id='label_18_97_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_97_2'>\n\t\t\t\t<input name='input_97' type='radio' value='Not Yet'  id='choice_18_97_2' tabindex='129'   \/>\n\t\t\t\t<label for='choice_18_97_2' id='label_18_97_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_99\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_99'>FINE MOTOR TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_18_99' type='text' value='' class='medium'   tabindex='130'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_100\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>PROBLEM SOLVING<\/h3><\/li><li id=\"field_18_101\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >When asked, \u201cWhich circle is smallest?\u201d does your child point to the smallest circle? (Ask this question without providing help by pointing, gesturing, or looking at the smallest circle.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_101'>\n\t\t\t<li class='gchoice gchoice_18_101_0'>\n\t\t\t\t<input name='input_101' type='radio' value='Yes'  id='choice_18_101_0' tabindex='131'   \/>\n\t\t\t\t<label for='choice_18_101_0' id='label_18_101_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_101_1'>\n\t\t\t\t<input name='input_101' type='radio' value='Sometimes'  id='choice_18_101_1' tabindex='132'   \/>\n\t\t\t\t<label for='choice_18_101_1' id='label_18_101_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_101_2'>\n\t\t\t\t<input name='input_101' type='radio' value='Not Yet'  id='choice_18_101_2' tabindex='133'   \/>\n\t\t\t\t<label for='choice_18_101_2' id='label_18_101_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_103\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-01-at-8.37.21-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_18_104\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >When shown objects and asked, \u201cWhat color is this?\u201d does your child name five different colors like red, blue, yellow, orange, black, white, or pink? (Mark \u201cyes\u201d only if your child answers the question correctly using five colors.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_104'>\n\t\t\t<li class='gchoice gchoice_18_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='Yes'  id='choice_18_104_0' tabindex='134'   \/>\n\t\t\t\t<label for='choice_18_104_0' id='label_18_104_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='Sometimes'  id='choice_18_104_1' tabindex='135'   \/>\n\t\t\t\t<label for='choice_18_104_1' id='label_18_104_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_104_2'>\n\t\t\t\t<input name='input_104' type='radio' value='Not Yet'  id='choice_18_104_2' tabindex='136'   \/>\n\t\t\t\t<label for='choice_18_104_2' id='label_18_104_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_105\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child count up to 15 without making mistakes? If so, mark \u201cyes.\u201d If your child counts to 12 without making mistakes, mark \u201csometimes.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_105'>\n\t\t\t<li class='gchoice gchoice_18_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='Yes'  id='choice_18_105_0' tabindex='137'   \/>\n\t\t\t\t<label for='choice_18_105_0' id='label_18_105_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_105_1'>\n\t\t\t\t<input name='input_105' type='radio' value='Sometimes'  id='choice_18_105_1' tabindex='138'   \/>\n\t\t\t\t<label for='choice_18_105_1' id='label_18_105_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_105_2'>\n\t\t\t\t<input name='input_105' type='radio' value='Not Yet'  id='choice_18_105_2' tabindex='139'   \/>\n\t\t\t\t<label for='choice_18_105_2' id='label_18_105_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_106\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child finish the following sentences using a word that means the opposite of the word that is italicized? For example: \u201cA rock is hard, and a pillow is soft.\u201d  Please write your child\u2019s responses below:  A cow is big, and a mouse is Ice is cold, and fire is We see stars at night, and we see the sun during the  When I throw the ball up, it comes  (Mark \u201cyes\u201d if he finishes three of four sentences correctly. Mark \u201csometimes\u201d if he finishes two of four sentences correctly.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_106'>\n\t\t\t<li class='gchoice gchoice_18_106_0'>\n\t\t\t\t<input name='input_106' type='radio' value='Yes'  id='choice_18_106_0' tabindex='140'   \/>\n\t\t\t\t<label for='choice_18_106_0' id='label_18_106_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_106_1'>\n\t\t\t\t<input name='input_106' type='radio' value='Sometimes'  id='choice_18_106_1' tabindex='141'   \/>\n\t\t\t\t<label for='choice_18_106_1' id='label_18_106_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_106_2'>\n\t\t\t\t<input name='input_106' type='radio' value='Not Yet'  id='choice_18_106_2' tabindex='142'   \/>\n\t\t\t\t<label for='choice_18_106_2' id='label_18_106_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_147\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_147'>Please write your child\u2019s response here:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_147' id='input_18_147' class='textarea medium' tabindex='143'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_107\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child know the names of numbers? (Mark \u201cyes\u201d if she identi- fies the three numbers below. Mark \u201csometimes\u201d if she identifies two numbers.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_107'>\n\t\t\t<li class='gchoice gchoice_18_107_0'>\n\t\t\t\t<input name='input_107' type='radio' value='Yes'  id='choice_18_107_0' tabindex='144'   \/>\n\t\t\t\t<label for='choice_18_107_0' id='label_18_107_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_107_1'>\n\t\t\t\t<input name='input_107' type='radio' value='Sometimes'  id='choice_18_107_1' tabindex='145'   \/>\n\t\t\t\t<label for='choice_18_107_1' id='label_18_107_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_107_2'>\n\t\t\t\t<input name='input_107' type='radio' value='Not Yet'  id='choice_18_107_2' tabindex='146'   \/>\n\t\t\t\t<label for='choice_18_107_2' id='label_18_107_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_151\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><img decoding=\"async\" src=\"https:\/\/www.youngmindsinmotion.com\/wp-content\/uploads\/2020\/08\/Screenshot-2020-08-05-at-8.07.37-PM.png\"\/ style=\"width:20%;\" ><\/li><li id=\"field_18_108\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child name at least four letters in her name? Point to the letters and ask, \u201cWhat letter is this?\u201d (Point to the letters out of order.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_108'>\n\t\t\t<li class='gchoice gchoice_18_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='Yes'  id='choice_18_108_0' tabindex='147'   \/>\n\t\t\t\t<label for='choice_18_108_0' id='label_18_108_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='Sometimes'  id='choice_18_108_1' tabindex='148'   \/>\n\t\t\t\t<label for='choice_18_108_1' id='label_18_108_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_108_2'>\n\t\t\t\t<input name='input_108' type='radio' value='Not Yet'  id='choice_18_108_2' tabindex='149'   \/>\n\t\t\t\t<label for='choice_18_108_2' id='label_18_108_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_110\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_110'>PROBLEM SOLVING TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_18_110' type='text' value='' class='medium'   tabindex='150'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_111\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>PERSONAL-SOCIAL<\/h3><\/li><li id=\"field_18_112\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Can your child serve himself, taking food from one container to another, using utensils? For example, does your child use a large spoon to scoop applesauce from a jar into a bowl?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_112'>\n\t\t\t<li class='gchoice gchoice_18_112_0'>\n\t\t\t\t<input name='input_112' type='radio' value='Yes'  id='choice_18_112_0' tabindex='151'   \/>\n\t\t\t\t<label for='choice_18_112_0' id='label_18_112_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_112_1'>\n\t\t\t\t<input name='input_112' type='radio' value='Sometimes'  id='choice_18_112_1' tabindex='152'   \/>\n\t\t\t\t<label for='choice_18_112_1' id='label_18_112_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_112_2'>\n\t\t\t\t<input name='input_112' type='radio' value='Not Yet'  id='choice_18_112_2' tabindex='153'   \/>\n\t\t\t\t<label for='choice_18_112_2' id='label_18_112_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_113\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child wash his hands using soap and water and dry them with a towel without help?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_113'>\n\t\t\t<li class='gchoice gchoice_18_113_0'>\n\t\t\t\t<input name='input_113' type='radio' value='Yes'  id='choice_18_113_0' tabindex='154'   \/>\n\t\t\t\t<label for='choice_18_113_0' id='label_18_113_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_113_1'>\n\t\t\t\t<input name='input_113' type='radio' value='Sometimes'  id='choice_18_113_1' tabindex='155'   \/>\n\t\t\t\t<label for='choice_18_113_1' id='label_18_113_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_113_2'>\n\t\t\t\t<input name='input_113' type='radio' value='Not Yet'  id='choice_18_113_2' tabindex='156'   \/>\n\t\t\t\t<label for='choice_18_113_2' id='label_18_113_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_117\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child tell you at least four of the following? 1. First name 2. Age 3. City he lives in 4. Last name 5. Boy or girl  6. Telephone number<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_117'>\n\t\t\t<li class='gchoice gchoice_18_117_0'>\n\t\t\t\t<input name='input_117' type='radio' value='Yes'  id='choice_18_117_0' tabindex='157'   \/>\n\t\t\t\t<label for='choice_18_117_0' id='label_18_117_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_117_1'>\n\t\t\t\t<input name='input_117' type='radio' value='Sometimes'  id='choice_18_117_1' tabindex='158'   \/>\n\t\t\t\t<label for='choice_18_117_1' id='label_18_117_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_117_2'>\n\t\t\t\t<input name='input_117' type='radio' value='Not Yet'  id='choice_18_117_2' tabindex='159'   \/>\n\t\t\t\t<label for='choice_18_117_2' id='label_18_117_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_114\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child dress and undress himself, including buttoning medium-size buttons and zipping front zippers?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_114'>\n\t\t\t<li class='gchoice gchoice_18_114_0'>\n\t\t\t\t<input name='input_114' type='radio' value='Yes'  id='choice_18_114_0' tabindex='160'   \/>\n\t\t\t\t<label for='choice_18_114_0' id='label_18_114_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_114_1'>\n\t\t\t\t<input name='input_114' type='radio' value='Sometimes'  id='choice_18_114_1' tabindex='161'   \/>\n\t\t\t\t<label for='choice_18_114_1' id='label_18_114_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_114_2'>\n\t\t\t\t<input name='input_114' type='radio' value='Not Yet'  id='choice_18_114_2' tabindex='162'   \/>\n\t\t\t\t<label for='choice_18_114_2' id='label_18_114_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_115\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child use the toilet by herself? (She goes to the bathroom, sits on the toilet, wipes, and flushes.) Mark \u201cyes\u201d even if she does this after you remind her.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_115'>\n\t\t\t<li class='gchoice gchoice_18_115_0'>\n\t\t\t\t<input name='input_115' type='radio' value='Yes'  id='choice_18_115_0' tabindex='163'   \/>\n\t\t\t\t<label for='choice_18_115_0' id='label_18_115_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_115_1'>\n\t\t\t\t<input name='input_115' type='radio' value='Sometimes'  id='choice_18_115_1' tabindex='164'   \/>\n\t\t\t\t<label for='choice_18_115_1' id='label_18_115_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_115_2'>\n\t\t\t\t<input name='input_115' type='radio' value='Not Yet'  id='choice_18_115_2' tabindex='165'   \/>\n\t\t\t\t<label for='choice_18_115_2' id='label_18_115_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_116\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does your child usually take turns and share with other children?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_116'>\n\t\t\t<li class='gchoice gchoice_18_116_0'>\n\t\t\t\t<input name='input_116' type='radio' value='Yes'  id='choice_18_116_0' tabindex='166'   \/>\n\t\t\t\t<label for='choice_18_116_0' id='label_18_116_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_116_1'>\n\t\t\t\t<input name='input_116' type='radio' value='Sometimes'  id='choice_18_116_1' tabindex='167'   \/>\n\t\t\t\t<label for='choice_18_116_1' id='label_18_116_1' class='gform-field-label gform-field-label--type-inline'>Sometimes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_116_2'>\n\t\t\t\t<input name='input_116' type='radio' value='Not Yet'  id='choice_18_116_2' tabindex='168'   \/>\n\t\t\t\t<label for='choice_18_116_2' id='label_18_116_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_118\" class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_118'>PERSONAL-SOCIAL TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_18_118' type='text' value='' class='medium'   tabindex='169'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_119\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>OVERALL<\/h3>\n<p class=\"p1\">Parents and providers may use the space below for additional comments.<\/p><\/li><li id=\"field_18_120\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you think your child hears well? If no, explain<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_120'>\n\t\t\t<li class='gchoice gchoice_18_120_0'>\n\t\t\t\t<input name='input_120' type='radio' value='Yes'  id='choice_18_120_0' tabindex='170'   \/>\n\t\t\t\t<label for='choice_18_120_0' id='label_18_120_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_120_1'>\n\t\t\t\t<input name='input_120' type='radio' value='No'  id='choice_18_120_1' tabindex='171'   \/>\n\t\t\t\t<label for='choice_18_120_1' id='label_18_120_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_122\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_122'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_122' id='input_18_122' class='textarea medium' tabindex='172'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_123\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you think your child talks like other children her age? If no, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_123'>\n\t\t\t<li class='gchoice gchoice_18_123_0'>\n\t\t\t\t<input name='input_123' type='radio' value='Yes'  id='choice_18_123_0' tabindex='173'   \/>\n\t\t\t\t<label for='choice_18_123_0' id='label_18_123_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_123_1'>\n\t\t\t\t<input name='input_123' type='radio' value='No'  id='choice_18_123_1' tabindex='174'   \/>\n\t\t\t\t<label for='choice_18_123_1' id='label_18_123_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_124\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_124'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_124' id='input_18_124' class='textarea medium' tabindex='175'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_125\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Can you understand most of what your child says? If no, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_125'>\n\t\t\t<li class='gchoice gchoice_18_125_0'>\n\t\t\t\t<input name='input_125' type='radio' value='Yes'  id='choice_18_125_0' tabindex='176'   \/>\n\t\t\t\t<label for='choice_18_125_0' id='label_18_125_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_125_1'>\n\t\t\t\t<input name='input_125' type='radio' value='No'  id='choice_18_125_1' tabindex='177'   \/>\n\t\t\t\t<label for='choice_18_125_1' id='label_18_125_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_126\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_126'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_126' id='input_18_126' class='textarea medium' tabindex='178'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_164\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Can other people understand most of what your child says? If no, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_164'>\n\t\t\t<li class='gchoice gchoice_18_164_0'>\n\t\t\t\t<input name='input_164' type='radio' value='Yes'  id='choice_18_164_0' tabindex='179'   \/>\n\t\t\t\t<label for='choice_18_164_0' id='label_18_164_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_164_1'>\n\t\t\t\t<input name='input_164' type='radio' value='No'  id='choice_18_164_1' tabindex='180'   \/>\n\t\t\t\t<label for='choice_18_164_1' id='label_18_164_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_165\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_165'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_165' id='input_18_165' class='textarea medium' tabindex='181'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_127\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you think your child walks, runs, and climbs like other toddlers his age? If no, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_127'>\n\t\t\t<li class='gchoice gchoice_18_127_0'>\n\t\t\t\t<input name='input_127' type='radio' value='Yes'  id='choice_18_127_0' tabindex='182'   \/>\n\t\t\t\t<label for='choice_18_127_0' id='label_18_127_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_127_1'>\n\t\t\t\t<input name='input_127' type='radio' value='No'  id='choice_18_127_1' tabindex='183'   \/>\n\t\t\t\t<label for='choice_18_127_1' id='label_18_127_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_128\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_128'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_128' id='input_18_128' class='textarea medium' tabindex='184'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_129\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does either parent have a family history of childhood deafness or hearing problems? If yes, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_129'>\n\t\t\t<li class='gchoice gchoice_18_129_0'>\n\t\t\t\t<input name='input_129' type='radio' value='Yes'  id='choice_18_129_0' tabindex='185'   \/>\n\t\t\t\t<label for='choice_18_129_0' id='label_18_129_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_129_1'>\n\t\t\t\t<input name='input_129' type='radio' value='No'  id='choice_18_129_1' tabindex='186'   \/>\n\t\t\t\t<label for='choice_18_129_1' id='label_18_129_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_130\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_130'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_130' id='input_18_130' class='textarea medium' tabindex='187'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_131\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have concerns about your child\u2019s eyesight? If yes, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_131'>\n\t\t\t<li class='gchoice gchoice_18_131_0'>\n\t\t\t\t<input name='input_131' type='radio' value='Yes'  id='choice_18_131_0' tabindex='188'   \/>\n\t\t\t\t<label for='choice_18_131_0' id='label_18_131_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_131_1'>\n\t\t\t\t<input name='input_131' type='radio' value='No'  id='choice_18_131_1' tabindex='189'   \/>\n\t\t\t\t<label for='choice_18_131_1' id='label_18_131_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_132\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_132'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_132' id='input_18_132' class='textarea medium' tabindex='190'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_133\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Has your child had any medical or health-related problems in the last few months? If yes, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_133'>\n\t\t\t<li class='gchoice gchoice_18_133_0'>\n\t\t\t\t<input name='input_133' type='radio' value='Yes'  id='choice_18_133_0' tabindex='191'   \/>\n\t\t\t\t<label for='choice_18_133_0' id='label_18_133_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_133_1'>\n\t\t\t\t<input name='input_133' type='radio' value='No'  id='choice_18_133_1' tabindex='192'   \/>\n\t\t\t\t<label for='choice_18_133_1' id='label_18_133_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_134\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_134'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_134' id='input_18_134' class='textarea medium' tabindex='193'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_135\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Do you have any concerns about your child\u2019s behaviour? If yes, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_135'>\n\t\t\t<li class='gchoice gchoice_18_135_0'>\n\t\t\t\t<input name='input_135' type='radio' value='Yes'  id='choice_18_135_0' tabindex='194'   \/>\n\t\t\t\t<label for='choice_18_135_0' id='label_18_135_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_135_1'>\n\t\t\t\t<input name='input_135' type='radio' value='No'  id='choice_18_135_1' tabindex='195'   \/>\n\t\t\t\t<label for='choice_18_135_1' id='label_18_135_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_136\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_136'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_136' id='input_18_136' class='textarea medium' tabindex='196'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_137\" class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Does anything about your child worry you? If yes, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_137'>\n\t\t\t<li class='gchoice gchoice_18_137_0'>\n\t\t\t\t<input name='input_137' type='radio' value='Yes'  id='choice_18_137_0' tabindex='197'   \/>\n\t\t\t\t<label for='choice_18_137_0' id='label_18_137_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_18_137_1'>\n\t\t\t\t<input name='input_137' type='radio' value='No'  id='choice_18_137_1' tabindex='198'   \/>\n\t\t\t\t<label for='choice_18_137_1' id='label_18_137_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_138\" class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label screen-reader-text' for='input_18_138'><\/label><div 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