{"id":3748,"date":"2020-08-05T12:37:04","date_gmt":"2020-08-05T16:37:04","guid":{"rendered":"https:\/\/youngmindsinmotion.com\/?page_id=3748"},"modified":"2020-08-15T19:01:13","modified_gmt":"2020-08-15T23:01:13","slug":"30-month-assessment","status":"publish","type":"page","link":"https:\/\/youngmindsinmotion.com\/es\/30-month-assessment\/","title":{"rendered":"Evaluaci\u00f3n de 30 meses"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3748\" class=\"elementor elementor-3748\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d787033 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d787033\" 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-fc5f7c5\" data-id=\"fc5f7c5\" 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-35a52c3 elementor-widget elementor-widget-wp-widget-gform_widget\" data-id=\"35a52c3\" 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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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_15_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_15_3'>Child&#039;s Name<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_15_3' type='text' value='' class='medium'   tabindex='1'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_4'>Child&#039;s Nickname<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_15_4' type='text' value='' class='medium'   tabindex='2'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_5'>Parents\u2019 Names<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_15_5' type='text' value='' class='medium'   tabindex='3'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_6'>Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_6' id='input_15_6' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='4'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_15_6_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_15_6_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_6' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_15_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_15_7'>Child\u2019s Teacher<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_15_7' type='text' value='' class='medium'   tabindex='5'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_8'><li class='gchoice gchoice_15_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_15_8_1' tabindex='6'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_8_1' id='label_15_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_15_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_15_8_2' tabindex='7'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_8_2' id='label_15_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_15_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_15_8_3' tabindex='8'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_8_3' id='label_15_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_15_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_15_9'>Please Specify<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_15_9' class='textarea medium' tabindex='9'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_10' class='textarea medium' tabindex='10'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_11'>Pets (Name &amp; type of animal)<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_15_11' type='text' value='' class='medium'   tabindex='11'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_12'>Father\u2019s Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_15_12' type='text' value='' class='medium'   tabindex='12'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_13'>Mother&#039;s Occupation<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_15_13' type='text' value='' class='medium'   tabindex='13'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_14'><li class='gchoice gchoice_15_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_15_14_1' tabindex='14'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_14_1' id='label_15_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_15_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_15_14_2' tabindex='15'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_14_2' id='label_15_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_15_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_15_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_15_15' type='text' value='' class='medium'   tabindex='16'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_16' class='textarea medium' tabindex='17'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_17' type='text' value='' class='medium'   tabindex='18'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_18'>Child\u2019s favorite TV programs<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_15_18' class='textarea medium' tabindex='19'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_19'>Hours per day spent watching TV<\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_15_19' type='text' value='' class='medium'   tabindex='20'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_20'><li class='gchoice gchoice_15_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_15_20_1' tabindex='21'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_1' id='label_15_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_15_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_15_20_2' tabindex='22'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_2' id='label_15_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_15_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_15_20_3' tabindex='23'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_3' id='label_15_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_15_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_15_20_4' tabindex='24'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_4' id='label_15_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_15_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_15_20_5' tabindex='25'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_5' id='label_15_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_15_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_15_20_6' tabindex='26'  \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_20_6' id='label_15_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_15_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_15_21'>Does child have decided fears?   If so, what?<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_15_21' type='text' value='' class='medium'   tabindex='27'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_22'>What responsibilities does your child have at home?<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_15_22' type='text' value='' class='medium'   tabindex='28'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_24'>What is your biggest discipline problem?<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_15_24' type='text' value='' class='medium'   tabindex='29'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_148\" 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_15_148'>How do you discipline your child?<\/label><div class='ginput_container ginput_container_text'><input name='input_148' id='input_15_148' type='text' value='' class='medium'   tabindex='30'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_25' type='text' value='' class='medium'   tabindex='31'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_26' type='text' value='' class='medium'   tabindex='32'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_149\" 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_15_149'>Is English your child\u2019s first language? If not, what is?<\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_15_149' type='text' value='' class='medium'   tabindex='33'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_27' type='text' value='' class='medium'   tabindex='34'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_28'>Does your child speak any English? \tUnderstand English?<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_15_28' type='text' value='' class='medium'   tabindex='35'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_29'>How does your child feel about coming to school?<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_15_29' type='text' value='' class='medium'   tabindex='36'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_30' type='text' value='' class='medium'   tabindex='37'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_31'>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_31' id='input_15_31' class='textarea medium' tabindex='38'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_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_15_33' class='textarea medium' tabindex='39'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_34' class='textarea medium' tabindex='40'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_35' class='textarea medium' tabindex='41'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_36' class='textarea medium' tabindex='42'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_37' class='textarea medium' tabindex='43'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_38' class='textarea medium' tabindex='44'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_39' class='textarea medium' tabindex='45'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_40' class='textarea medium' tabindex='46'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_42'>What is the most important thing I should know about your child?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_42' id='input_15_42' class='textarea medium' tabindex='47'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_43'>What are their strengths?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_15_43' class='textarea medium' tabindex='48'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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_15_44' class='textarea medium' tabindex='49'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_45'>My child learns best when the teacher is\u2026.<\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_15_45' type='text' value='' class='medium'   tabindex='50'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_46'>My child does not work well with\u2026<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_15_46' type='text' value='' class='medium'   tabindex='51'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_47'>What is the best way to motivate your child?<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_15_47' type='text' value='' class='medium'   tabindex='52'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_48'>What are you looking forward to at YMIM?<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_15_48' type='text' value='' class='medium'   tabindex='53'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_49' type='text' value='' class='medium'   tabindex='54'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_50' type='text' value='' class='medium'   tabindex='55'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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-3.53.41-PM.png\"\/ style=\"width:430px; height:150px; margin-top:50px;\"><\/li><li id=\"field_15_150\" 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_15_150'>Child\u2019s date of birth:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_150' id='input_15_150' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='56'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_15_150_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_15_150_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_150' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_15_152\" 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_15_152'>\n\t\t\t<li class='gchoice gchoice_15_152_0'>\n\t\t\t\t<input name='input_152' type='radio' value='Boy'  id='choice_15_152_0' tabindex='57'   \/>\n\t\t\t\t<label for='choice_15_152_0' id='label_15_152_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_15_152_1'>\n\t\t\t\t<input name='input_152' type='radio' value='Girl'  id='choice_15_152_1' tabindex='58'   \/>\n\t\t\t\t<label for='choice_15_152_1' id='label_15_152_1' class='gform-field-label gform-field-label--type-inline'>Girl<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_155\" 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_15_155'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_155' id='input_15_155' type='email' value='' class='medium' tabindex='59'    aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_15_151\" 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_15_151'>Date ASQ-3 completed by parent\/caregiver:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_151' id='input_15_151' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='60'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_15_151_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_15_151_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_151' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_15_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_15_54'>Date of review with health professional:<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_54' id='input_15_54' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='61'  placeholder='mm\/dd\/aaaa' aria-describedby=\"input_15_54_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_15_54_date_format' class='screen-reader-text'>MM barra DD barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_15_54' class='gform_hidden' value='https:\/\/youngmindsinmotion.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_15_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_15_56'>Child\u2019s home address<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_15_56' type='text' value='' class='medium'   tabindex='62'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_57'>Town<\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_15_57' type='text' value='' class='medium'   tabindex='63'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_58'>Postcode<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_15_58' type='text' value='' class='medium'   tabindex='64'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_59'>Person completing the questionnaire<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_15_59' type='text' value='' class='medium'   tabindex='65'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_60'>Relationship to child:<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_15_60' type='text' value='' class='medium'   tabindex='66'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_61'>Home tel:<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_15_61' type='text' value='' class='medium'   tabindex='67'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_62'>Mobile no<\/label><div class='ginput_container ginput_container_text'><input name='input_62' id='input_15_62' type='text' value='' class='medium'   tabindex='68'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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-3.55.47-PM.png\"\/ style=\" display: block; margin-left: auto;\n  margin-right: auto;\"><\/li><li id=\"field_15_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_15_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_15_67'>Additional Notes<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_15_67' class='textarea medium' tabindex='69'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_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' >If you point to a picture of a ball (cat, cup, hat, etc.) and ask your child, \u201cWhat is this?\u201d does your child correctly name at least one picture?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_72'>\n\t\t\t<li class='gchoice gchoice_15_72_0'>\n\t\t\t\t<input name='input_72' type='radio' value='Yes'  id='choice_15_72_0' tabindex='70'   \/>\n\t\t\t\t<label for='choice_15_72_0' id='label_15_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_15_72_1'>\n\t\t\t\t<input name='input_72' type='radio' value='Sometimes'  id='choice_15_72_1' tabindex='71'   \/>\n\t\t\t\t<label for='choice_15_72_1' id='label_15_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_15_72_2'>\n\t\t\t\t<input name='input_72' type='radio' value='Not Yet'  id='choice_15_72_2' tabindex='72'   \/>\n\t\t\t\t<label for='choice_15_72_2' id='label_15_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_15_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' >Without giving him clues by pointing or using gestures, can your child carry out at least three of these kinds of directions? 1. \u201cPut the toy on the table.\u201d   2. \u201cClose the door.\u201d  3.\u201cBring me a towel.\u201d 4. \u201cFind your coat.\u201d 5.\u201cTake my hand.\u201d 6. \u201cGet your book.\u201d<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_71'>\n\t\t\t<li class='gchoice gchoice_15_71_0'>\n\t\t\t\t<input name='input_71' type='radio' value='Yes'  id='choice_15_71_0' tabindex='73'   \/>\n\t\t\t\t<label for='choice_15_71_0' id='label_15_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_15_71_1'>\n\t\t\t\t<input name='input_71' type='radio' value='Sometimes'  id='choice_15_71_1' tabindex='74'   \/>\n\t\t\t\t<label for='choice_15_71_1' id='label_15_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_15_71_2'>\n\t\t\t\t<input name='input_71' type='radio' value='Not Yet'  id='choice_15_71_2' tabindex='75'   \/>\n\t\t\t\t<label for='choice_15_71_2' id='label_15_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_15_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' >When you ask your child to point to her nose, eyes, hair, feet, ears, etc., does she correctly point to at least seven body parts? (She can point to parts of herself, you, or a doll. Mark \u201csometimes\u201d if he\/she correctly points to at least three different body parts.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_139'>\n\t\t\t<li class='gchoice gchoice_15_139_0'>\n\t\t\t\t<input name='input_139' type='radio' value='Yes'  id='choice_15_139_0' tabindex='76'   \/>\n\t\t\t\t<label for='choice_15_139_0' id='label_15_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_15_139_1'>\n\t\t\t\t<input name='input_139' type='radio' value='Sometimes'  id='choice_15_139_1' tabindex='77'   \/>\n\t\t\t\t<label for='choice_15_139_1' id='label_15_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_15_139_2'>\n\t\t\t\t<input name='input_139' type='radio' value='Not Yet'  id='choice_15_139_2' tabindex='78'   \/>\n\t\t\t\t<label for='choice_15_139_2' id='label_15_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_15_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 make sentences that are three or four words long?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_69'>\n\t\t\t<li class='gchoice gchoice_15_69_0'>\n\t\t\t\t<input name='input_69' type='radio' value='Yes'  id='choice_15_69_0' tabindex='79'   \/>\n\t\t\t\t<label for='choice_15_69_0' id='label_15_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_15_69_1'>\n\t\t\t\t<input name='input_69' type='radio' value='Sometimes'  id='choice_15_69_1' tabindex='80'   \/>\n\t\t\t\t<label for='choice_15_69_1' id='label_15_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_15_69_2'>\n\t\t\t\t<input name='input_69' type='radio' value='Not Yet'  id='choice_15_69_2' tabindex='81'   \/>\n\t\t\t\t<label for='choice_15_69_2' id='label_15_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_15_74\" 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_15_74'>Please give an example of your child\u2019s word combinations:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_15_74' class='textarea medium' tabindex='82'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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' >Without giving your child help by pointing or using gestures, ask him to \u201cput the book on the table\u201d and \u201cput the shoe under the chair.\u201d Does your child carry out both of these directions correctly?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_70'>\n\t\t\t<li class='gchoice gchoice_15_70_0'>\n\t\t\t\t<input name='input_70' type='radio' value='Yes'  id='choice_15_70_0' tabindex='83'   \/>\n\t\t\t\t<label for='choice_15_70_0' id='label_15_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_15_70_1'>\n\t\t\t\t<input name='input_70' type='radio' value='Sometimes'  id='choice_15_70_1' tabindex='84'   \/>\n\t\t\t\t<label for='choice_15_70_1' id='label_15_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_15_70_2'>\n\t\t\t\t<input name='input_70' type='radio' value='Not Yet'  id='choice_15_70_2' tabindex='85'   \/>\n\t\t\t\t<label for='choice_15_70_2' id='label_15_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_15_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' >When looking at a picture book, does your child tell you what is happening or what action is taking place in the picture (for example, \u201cbarking,\u201d \u201crunning,\u201d \u201ceating,\u201d or \u201ccrying\u201d)? You may ask, \u201cWhat is the dog (or boy) doing?\u201d<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_73'>\n\t\t\t<li class='gchoice gchoice_15_73_0'>\n\t\t\t\t<input name='input_73' type='radio' value='Yes'  id='choice_15_73_0' tabindex='86'   \/>\n\t\t\t\t<label for='choice_15_73_0' id='label_15_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_15_73_1'>\n\t\t\t\t<input name='input_73' type='radio' value='Sometimes'  id='choice_15_73_1' tabindex='87'   \/>\n\t\t\t\t<label for='choice_15_73_1' id='label_15_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_15_73_2'>\n\t\t\t\t<input name='input_73' type='radio' value='Not Yet'  id='choice_15_73_2' tabindex='88'   \/>\n\t\t\t\t<label for='choice_15_73_2' id='label_15_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_15_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_15_76'>Communication Total<\/label><div class='ginput_container ginput_container_text'><input name='input_76' id='input_15_76' type='text' value='' class='medium'   tabindex='89'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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' >Does your child run fairly well, stopping herself without bumping into things or falling over?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_78'>\n\t\t\t<li class='gchoice gchoice_15_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='Yes'  id='choice_15_78_0' tabindex='90'   \/>\n\t\t\t\t<label for='choice_15_78_0' id='label_15_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_15_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='Sometimes'  id='choice_15_78_1' tabindex='91'   \/>\n\t\t\t\t<label for='choice_15_78_1' id='label_15_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_15_78_2'>\n\t\t\t\t<input name='input_78' type='radio' value='Not Yet'  id='choice_15_78_2' tabindex='92'   \/>\n\t\t\t\t<label for='choice_15_78_2' id='label_15_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_15_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\/07\/Screenshot-2020-08-01-at-2.08.49-AM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_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 walk either up or down at least two steps by himself? He may hold onto the handrail or wall. (You can look for this in a shop, in a playground, or at home.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_79'>\n\t\t\t<li class='gchoice gchoice_15_79_0'>\n\t\t\t\t<input name='input_79' type='radio' value='Yes'  id='choice_15_79_0' tabindex='93'   \/>\n\t\t\t\t<label for='choice_15_79_0' id='label_15_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_15_79_1'>\n\t\t\t\t<input name='input_79' type='radio' value='Sometimes'  id='choice_15_79_1' tabindex='94'   \/>\n\t\t\t\t<label for='choice_15_79_1' id='label_15_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_15_79_2'>\n\t\t\t\t<input name='input_79' type='radio' value='Not Yet'  id='choice_15_79_2' tabindex='95'   \/>\n\t\t\t\t<label for='choice_15_79_2' id='label_15_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_15_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\/07\/Screenshot-2020-08-01-at-2.07.16-AM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_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' >Without holding onto anything for support, does your child kick a ball by swinging his leg forward?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_82'>\n\t\t\t<li class='gchoice gchoice_15_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Yes'  id='choice_15_82_0' tabindex='96'   \/>\n\t\t\t\t<label for='choice_15_82_0' id='label_15_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_15_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='Sometimes'  id='choice_15_82_1' tabindex='97'   \/>\n\t\t\t\t<label for='choice_15_82_1' id='label_15_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_15_82_2'>\n\t\t\t\t<input name='input_82' type='radio' value='Not Yet'  id='choice_15_82_2' tabindex='98'   \/>\n\t\t\t\t<label for='choice_15_82_2' id='label_15_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_15_83\" 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\/07\/Screenshot-2020-08-01-at-2.13.34-AM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_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 jump with both feet leaving the floor at the same time?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_84'>\n\t\t\t<li class='gchoice gchoice_15_84_0'>\n\t\t\t\t<input name='input_84' type='radio' value='Yes'  id='choice_15_84_0' tabindex='99'   \/>\n\t\t\t\t<label for='choice_15_84_0' id='label_15_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_15_84_1'>\n\t\t\t\t<input name='input_84' type='radio' value='Sometimes'  id='choice_15_84_1' tabindex='100'   \/>\n\t\t\t\t<label for='choice_15_84_1' id='label_15_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_15_84_2'>\n\t\t\t\t<input name='input_84' type='radio' value='Not Yet'  id='choice_15_84_2' tabindex='101'   \/>\n\t\t\t\t<label for='choice_15_84_2' id='label_15_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_15_85\" 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\/07\/Screenshot-2020-08-01-at-2.11.39-AM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_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 walk up stairs, using only one foot on each stair? (The left foot is on one step, and the right foot is on the next.) He\/She may hold onto the handrail or wall.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_86'>\n\t\t\t<li class='gchoice gchoice_15_86_0'>\n\t\t\t\t<input name='input_86' type='radio' value='Yes'  id='choice_15_86_0' tabindex='102'   \/>\n\t\t\t\t<label for='choice_15_86_0' id='label_15_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_15_86_1'>\n\t\t\t\t<input name='input_86' type='radio' value='Sometimes'  id='choice_15_86_1' tabindex='103'   \/>\n\t\t\t\t<label for='choice_15_86_1' id='label_15_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_15_86_2'>\n\t\t\t\t<input name='input_86' type='radio' value='Not Yet'  id='choice_15_86_2' tabindex='104'   \/>\n\t\t\t\t<label for='choice_15_86_2' id='label_15_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_15_87\" 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-5.00.41-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_88\" 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 stand on one foot for about 1 second without holding on to anything?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_88'>\n\t\t\t<li class='gchoice gchoice_15_88_0'>\n\t\t\t\t<input name='input_88' type='radio' value='Yes'  id='choice_15_88_0' tabindex='105'   \/>\n\t\t\t\t<label for='choice_15_88_0' id='label_15_88_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_15_88_1'>\n\t\t\t\t<input name='input_88' type='radio' value='Sometimes'  id='choice_15_88_1' tabindex='106'   \/>\n\t\t\t\t<label for='choice_15_88_1' id='label_15_88_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_15_88_2'>\n\t\t\t\t<input name='input_88' type='radio' value='Not Yet'  id='choice_15_88_2' tabindex='107'   \/>\n\t\t\t\t<label for='choice_15_88_2' id='label_15_88_2' class='gform-field-label gform-field-label--type-inline'>Not Yet<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_89\" 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_15_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_15_90'>GROSS MOTOR TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_15_90' type='text' value='' class='medium'   tabindex='108'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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' >Does your child use a turning motion with her hand while trying to turn doorknobs, wind up toys, twist tops, or screw lids on and off jars?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_92'>\n\t\t\t<li class='gchoice gchoice_15_92_0'>\n\t\t\t\t<input name='input_92' type='radio' value='Yes'  id='choice_15_92_0' tabindex='109'   \/>\n\t\t\t\t<label for='choice_15_92_0' id='label_15_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_15_92_1'>\n\t\t\t\t<input name='input_92' type='radio' value='Sometimes'  id='choice_15_92_1' tabindex='110'   \/>\n\t\t\t\t<label for='choice_15_92_1' id='label_15_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_15_92_2'>\n\t\t\t\t<input name='input_92' type='radio' value='Not Yet'  id='choice_15_92_2' tabindex='111'   \/>\n\t\t\t\t<label for='choice_15_92_2' id='label_15_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_15_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' >After your child watches you draw a line from the top of the paper to the bottom with a pencil, crayon, or pen, ask him to make a line like yours. Do not let your child trace your line. Does your child copy you by drawing a single line in a vertical direction?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_93'>\n\t\t\t<li class='gchoice gchoice_15_93_0'>\n\t\t\t\t<input name='input_93' type='radio' value='Yes'  id='choice_15_93_0' tabindex='112'   \/>\n\t\t\t\t<label for='choice_15_93_0' id='label_15_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_15_93_1'>\n\t\t\t\t<input name='input_93' type='radio' value='Sometimes'  id='choice_15_93_1' tabindex='113'   \/>\n\t\t\t\t<label for='choice_15_93_1' id='label_15_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_15_93_2'>\n\t\t\t\t<input name='input_93' type='radio' value='Not Yet'  id='choice_15_93_2' tabindex='114'   \/>\n\t\t\t\t<label for='choice_15_93_2' id='label_15_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_15_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\/07\/Screenshot-2020-08-01-at-2.28.05-AM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_15_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' >Can your child string small items such as pasta or beads onto a string or shoelace? (Carefully watch your child\u2019s use of beads and string for safety reasons.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_94'>\n\t\t\t<li class='gchoice gchoice_15_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value='Yes'  id='choice_15_94_0' tabindex='115'   \/>\n\t\t\t\t<label for='choice_15_94_0' id='label_15_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_15_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='Sometimes'  id='choice_15_94_1' tabindex='116'   \/>\n\t\t\t\t<label for='choice_15_94_1' id='label_15_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_15_94_2'>\n\t\t\t\t<input name='input_94' type='radio' value='Not Yet'  id='choice_15_94_2' tabindex='117'   \/>\n\t\t\t\t<label for='choice_15_94_2' id='label_15_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_15_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\/07\/Screenshot-2020-08-01-at-2.24.33-AM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_15_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' >After your child watches you draw a line from one side of the paper to the other side, ask her to make a line like yours. Do not let your child trace your line. Does your child copy you by drawing a single line in a horizontal direction?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_95'>\n\t\t\t<li class='gchoice gchoice_15_95_0'>\n\t\t\t\t<input name='input_95' type='radio' value='Yes'  id='choice_15_95_0' tabindex='118'   \/>\n\t\t\t\t<label for='choice_15_95_0' id='label_15_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_15_95_1'>\n\t\t\t\t<input name='input_95' type='radio' value='Sometimes'  id='choice_15_95_1' tabindex='119'   \/>\n\t\t\t\t<label for='choice_15_95_1' id='label_15_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_15_95_2'>\n\t\t\t\t<input name='input_95' type='radio' value='Not Yet'  id='choice_15_95_2' tabindex='120'   \/>\n\t\t\t\t<label for='choice_15_95_2' id='label_15_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_15_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-5.10.48-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_15_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' >After your child watches you draw a single circle, ask him to make a circle like yours. Do not let him trace your circle. Does your child copy you by drawing a circle?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_96'>\n\t\t\t<li class='gchoice gchoice_15_96_0'>\n\t\t\t\t<input name='input_96' type='radio' value='Yes'  id='choice_15_96_0' tabindex='121'   \/>\n\t\t\t\t<label for='choice_15_96_0' id='label_15_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_15_96_1'>\n\t\t\t\t<input name='input_96' type='radio' value='Sometimes'  id='choice_15_96_1' tabindex='122'   \/>\n\t\t\t\t<label for='choice_15_96_1' id='label_15_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_15_96_2'>\n\t\t\t\t<input name='input_96' type='radio' value='Not Yet'  id='choice_15_96_2' tabindex='123'   \/>\n\t\t\t\t<label for='choice_15_96_2' id='label_15_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_15_144\" 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-5.12.52-PM.png\"\/  style=\"width:20%;\"><\/li><li id=\"field_15_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' >Does your child turn pages in a book, one page at a time?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_97'>\n\t\t\t<li class='gchoice gchoice_15_97_0'>\n\t\t\t\t<input name='input_97' type='radio' value='Yes'  id='choice_15_97_0' tabindex='124'   \/>\n\t\t\t\t<label for='choice_15_97_0' id='label_15_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_15_97_1'>\n\t\t\t\t<input name='input_97' type='radio' value='Sometimes'  id='choice_15_97_1' tabindex='125'   \/>\n\t\t\t\t<label for='choice_15_97_1' id='label_15_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_15_97_2'>\n\t\t\t\t<input name='input_97' type='radio' value='Not Yet'  id='choice_15_97_2' tabindex='126'   \/>\n\t\t\t\t<label for='choice_15_97_2' id='label_15_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_15_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_15_99'>FINE MOTOR TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_15_99' type='text' value='' class='medium'   tabindex='127'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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 looking in the mirror, ask, \u201cWhere is ______?\u201d (Use your child\u2019s name.) Does your child point to her image in the mirror?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_101'>\n\t\t\t<li class='gchoice gchoice_15_101_0'>\n\t\t\t\t<input name='input_101' type='radio' value='Yes'  id='choice_15_101_0' tabindex='128'   \/>\n\t\t\t\t<label for='choice_15_101_0' id='label_15_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_15_101_1'>\n\t\t\t\t<input name='input_101' type='radio' value='Sometimes'  id='choice_15_101_1' tabindex='129'   \/>\n\t\t\t\t<label for='choice_15_101_1' id='label_15_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_15_101_2'>\n\t\t\t\t<input name='input_101' type='radio' value='Not Yet'  id='choice_15_101_2' tabindex='130'   \/>\n\t\t\t\t<label for='choice_15_101_2' id='label_15_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_15_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-5.16.08-PM.png\"\/ style=\"width:20%;\"><\/li><li id=\"field_15_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' >If your child wants something he cannot reach, does he find a chair or box to stand on to reach it (for example, to reach a toy on a table or worktop or to \u201chelp\u201d you in the kitchen)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_104'>\n\t\t\t<li class='gchoice gchoice_15_104_0'>\n\t\t\t\t<input name='input_104' type='radio' value='Yes'  id='choice_15_104_0' tabindex='131'   \/>\n\t\t\t\t<label for='choice_15_104_0' id='label_15_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_15_104_1'>\n\t\t\t\t<input name='input_104' type='radio' value='Sometimes'  id='choice_15_104_1' tabindex='132'   \/>\n\t\t\t\t<label for='choice_15_104_1' id='label_15_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_15_104_2'>\n\t\t\t\t<input name='input_104' type='radio' value='Not Yet'  id='choice_15_104_2' tabindex='133'   \/>\n\t\t\t\t<label for='choice_15_104_2' id='label_15_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_15_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' >While your child watches, line up four objects like blocks or cars in a row. Does your child copy or imitate you and line up four objects in a row? (You can also use cotton reels, small boxes, or other toys.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_105'>\n\t\t\t<li class='gchoice gchoice_15_105_0'>\n\t\t\t\t<input name='input_105' type='radio' value='Yes'  id='choice_15_105_0' tabindex='134'   \/>\n\t\t\t\t<label for='choice_15_105_0' id='label_15_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_15_105_1'>\n\t\t\t\t<input name='input_105' type='radio' value='Sometimes'  id='choice_15_105_1' tabindex='135'   \/>\n\t\t\t\t<label for='choice_15_105_1' id='label_15_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_15_105_2'>\n\t\t\t\t<input name='input_105' type='radio' value='Not Yet'  id='choice_15_105_2' tabindex='136'   \/>\n\t\t\t\t<label for='choice_15_105_2' id='label_15_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_15_145\" 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\/07\/Screenshot-2020-08-01-at-2.38.54-AM.png\"\/ style=\"width:20%;\" ><\/li><li id=\"field_15_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' >When you point to the figure and ask your child, \u201cWhat is this?\u201d does your child say a word that means a person or something similar? (Mark \u201cyes\u201d for responses like \u201csnowman,\u201d \u201cboy,\u201d \u201cman,\u201d \u201cgirl,\u201d \u201cDaddy,\u201d \u201cspaceman,\u201d and \u201cmonkey.\u201d)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_106'>\n\t\t\t<li class='gchoice gchoice_15_106_0'>\n\t\t\t\t<input name='input_106' type='radio' value='Yes'  id='choice_15_106_0' tabindex='137'   \/>\n\t\t\t\t<label for='choice_15_106_0' id='label_15_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_15_106_1'>\n\t\t\t\t<input name='input_106' type='radio' value='Sometimes'  id='choice_15_106_1' tabindex='138'   \/>\n\t\t\t\t<label for='choice_15_106_1' id='label_15_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_15_106_2'>\n\t\t\t\t<input name='input_106' type='radio' value='Not Yet'  id='choice_15_106_2' tabindex='139'   \/>\n\t\t\t\t<label for='choice_15_106_2' id='label_15_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_15_146\" 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-5.42.09-PM.png\"\/ style=\"width:20%;\" ><\/li><li id=\"field_15_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_15_147'>Please write your child\u2019s response here:<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_147' id='input_15_147' class='textarea medium' tabindex='140'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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' >When you say, \u201cSay, \u2018seven three,\u2019\u201d does your child repeat just the two numbers in the same order? Do not repeat the numbers. If necessary, try another pair of numbers and say, \u201cSay, \u2018eight two.\u2019\u201d Your child must repeat just one series of two numbers for you to answer \u201cyes\u201d to this question.<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_107'>\n\t\t\t<li class='gchoice gchoice_15_107_0'>\n\t\t\t\t<input name='input_107' type='radio' value='Yes'  id='choice_15_107_0' tabindex='141'   \/>\n\t\t\t\t<label for='choice_15_107_0' id='label_15_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_15_107_1'>\n\t\t\t\t<input name='input_107' type='radio' value='Sometimes'  id='choice_15_107_1' tabindex='142'   \/>\n\t\t\t\t<label for='choice_15_107_1' id='label_15_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_15_107_2'>\n\t\t\t\t<input name='input_107' type='radio' value='Not Yet'  id='choice_15_107_2' tabindex='143'   \/>\n\t\t\t\t<label for='choice_15_107_2' id='label_15_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_15_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' >After your child draws a \u201cpicture,\u201d even a simple scribble, does she tell you what she drew? (You may say, \u201cTell me about your picture,\u201d or ask, \u201cWhat is this?\u201d to prompt her.)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_108'>\n\t\t\t<li class='gchoice gchoice_15_108_0'>\n\t\t\t\t<input name='input_108' type='radio' value='Yes'  id='choice_15_108_0' tabindex='144'   \/>\n\t\t\t\t<label for='choice_15_108_0' id='label_15_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_15_108_1'>\n\t\t\t\t<input name='input_108' type='radio' value='Sometimes'  id='choice_15_108_1' tabindex='145'   \/>\n\t\t\t\t<label for='choice_15_108_1' id='label_15_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_15_108_2'>\n\t\t\t\t<input name='input_108' type='radio' value='Not Yet'  id='choice_15_108_2' tabindex='146'   \/>\n\t\t\t\t<label for='choice_15_108_2' id='label_15_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_15_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_15_110'>PROBLEM SOLVING TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_110' id='input_15_110' type='text' value='' class='medium'   tabindex='147'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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' >If you do any of the following gestures, does your child copy at least one of them? 1. Open and close your mouth 2.Blink your eyes. 3. Pull on your earlobe. 4. Pat your cheek<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_112'>\n\t\t\t<li class='gchoice gchoice_15_112_0'>\n\t\t\t\t<input name='input_112' type='radio' value='Yes'  id='choice_15_112_0' tabindex='148'   \/>\n\t\t\t\t<label for='choice_15_112_0' id='label_15_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_15_112_1'>\n\t\t\t\t<input name='input_112' type='radio' value='Sometimes'  id='choice_15_112_1' tabindex='149'   \/>\n\t\t\t\t<label for='choice_15_112_1' id='label_15_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_15_112_2'>\n\t\t\t\t<input name='input_112' type='radio' value='Not Yet'  id='choice_15_112_2' tabindex='150'   \/>\n\t\t\t\t<label for='choice_15_112_2' id='label_15_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_15_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 use a knife\/fork and spoon to feed himself?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_113'>\n\t\t\t<li class='gchoice gchoice_15_113_0'>\n\t\t\t\t<input name='input_113' type='radio' value='Yes'  id='choice_15_113_0' tabindex='151'   \/>\n\t\t\t\t<label for='choice_15_113_0' id='label_15_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_15_113_1'>\n\t\t\t\t<input name='input_113' type='radio' value='Sometimes'  id='choice_15_113_1' tabindex='152'   \/>\n\t\t\t\t<label for='choice_15_113_1' id='label_15_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_15_113_2'>\n\t\t\t\t<input name='input_113' type='radio' value='Not Yet'  id='choice_15_113_2' tabindex='153'   \/>\n\t\t\t\t<label for='choice_15_113_2' id='label_15_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_15_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 push a little truck, doll\u2019s buggy, or other toy on wheels, steering around objects and backing out of corners if she cannot turn?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_117'>\n\t\t\t<li class='gchoice gchoice_15_117_0'>\n\t\t\t\t<input name='input_117' type='radio' value='Yes'  id='choice_15_117_0' tabindex='154'   \/>\n\t\t\t\t<label for='choice_15_117_0' id='label_15_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_15_117_1'>\n\t\t\t\t<input name='input_117' type='radio' value='Sometimes'  id='choice_15_117_1' tabindex='155'   \/>\n\t\t\t\t<label for='choice_15_117_1' id='label_15_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_15_117_2'>\n\t\t\t\t<input name='input_117' type='radio' value='Not Yet'  id='choice_15_117_2' tabindex='156'   \/>\n\t\t\t\t<label for='choice_15_117_2' id='label_15_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_15_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 put on a coat, jacket, or shirt by himself?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_114'>\n\t\t\t<li class='gchoice gchoice_15_114_0'>\n\t\t\t\t<input name='input_114' type='radio' value='Yes'  id='choice_15_114_0' tabindex='157'   \/>\n\t\t\t\t<label for='choice_15_114_0' id='label_15_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_15_114_1'>\n\t\t\t\t<input name='input_114' type='radio' value='Sometimes'  id='choice_15_114_1' tabindex='158'   \/>\n\t\t\t\t<label for='choice_15_114_1' id='label_15_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_15_114_2'>\n\t\t\t\t<input name='input_114' type='radio' value='Not Yet'  id='choice_15_114_2' tabindex='159'   \/>\n\t\t\t\t<label for='choice_15_114_2' id='label_15_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_15_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' >After you put on loose-fitting trousers around her feet, does your child pull them completely up to her waist?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_115'>\n\t\t\t<li class='gchoice gchoice_15_115_0'>\n\t\t\t\t<input name='input_115' type='radio' value='Yes'  id='choice_15_115_0' tabindex='160'   \/>\n\t\t\t\t<label for='choice_15_115_0' id='label_15_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_15_115_1'>\n\t\t\t\t<input name='input_115' type='radio' value='Sometimes'  id='choice_15_115_1' tabindex='161'   \/>\n\t\t\t\t<label for='choice_15_115_1' id='label_15_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_15_115_2'>\n\t\t\t\t<input name='input_115' type='radio' value='Not Yet'  id='choice_15_115_2' tabindex='162'   \/>\n\t\t\t\t<label for='choice_15_115_2' id='label_15_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_15_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' >When your child is looking in a mirror and you ask, \u201cWho is in the mirror?\u201d does he say either \u201cme\u201d or his own name?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_116'>\n\t\t\t<li class='gchoice gchoice_15_116_0'>\n\t\t\t\t<input name='input_116' type='radio' value='Yes'  id='choice_15_116_0' tabindex='163'   \/>\n\t\t\t\t<label for='choice_15_116_0' id='label_15_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_15_116_1'>\n\t\t\t\t<input name='input_116' type='radio' value='Sometimes'  id='choice_15_116_1' tabindex='164'   \/>\n\t\t\t\t<label for='choice_15_116_1' id='label_15_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_15_116_2'>\n\t\t\t\t<input name='input_116' type='radio' value='Not Yet'  id='choice_15_116_2' tabindex='165'   \/>\n\t\t\t\t<label for='choice_15_116_2' id='label_15_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_15_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_15_118'>PERSONAL-SOCIAL TOTAL<\/label><div class='ginput_container ginput_container_text'><input name='input_118' id='input_15_118' type='text' value='' class='medium'   tabindex='166'   aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_15_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_15_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_15_120'>\n\t\t\t<li class='gchoice gchoice_15_120_0'>\n\t\t\t\t<input name='input_120' type='radio' value='Yes'  id='choice_15_120_0' tabindex='167'   \/>\n\t\t\t\t<label for='choice_15_120_0' id='label_15_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_15_120_1'>\n\t\t\t\t<input name='input_120' type='radio' value='No'  id='choice_15_120_1' tabindex='168'   \/>\n\t\t\t\t<label for='choice_15_120_1' id='label_15_120_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_122'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_122' id='input_15_122' class='textarea medium' tabindex='169'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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 toddlers her age? If no, explain:<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_15_123'>\n\t\t\t<li class='gchoice gchoice_15_123_0'>\n\t\t\t\t<input name='input_123' type='radio' value='Yes'  id='choice_15_123_0' tabindex='170'   \/>\n\t\t\t\t<label for='choice_15_123_0' id='label_15_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_15_123_1'>\n\t\t\t\t<input name='input_123' type='radio' value='No'  id='choice_15_123_1' tabindex='171'   \/>\n\t\t\t\t<label for='choice_15_123_1' id='label_15_123_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_124'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_124' id='input_15_124' class='textarea medium' tabindex='172'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_125'>\n\t\t\t<li class='gchoice gchoice_15_125_0'>\n\t\t\t\t<input name='input_125' type='radio' value='Yes'  id='choice_15_125_0' tabindex='173'   \/>\n\t\t\t\t<label for='choice_15_125_0' id='label_15_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_15_125_1'>\n\t\t\t\t<input name='input_125' type='radio' value='No'  id='choice_15_125_1' tabindex='174'   \/>\n\t\t\t\t<label for='choice_15_125_1' id='label_15_125_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_126'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_126' id='input_15_126' class='textarea medium' tabindex='175'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_153\" 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_15_153'>\n\t\t\t<li class='gchoice gchoice_15_153_0'>\n\t\t\t\t<input name='input_153' type='radio' value='Yes'  id='choice_15_153_0' tabindex='176'   \/>\n\t\t\t\t<label for='choice_15_153_0' id='label_15_153_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_15_153_1'>\n\t\t\t\t<input name='input_153' type='radio' value='No'  id='choice_15_153_1' tabindex='177'   \/>\n\t\t\t\t<label for='choice_15_153_1' id='label_15_153_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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 screen-reader-text' for='input_15_154'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_154' id='input_15_154' class='textarea medium' tabindex='178'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_127'>\n\t\t\t<li class='gchoice gchoice_15_127_0'>\n\t\t\t\t<input name='input_127' type='radio' value='Yes'  id='choice_15_127_0' tabindex='179'   \/>\n\t\t\t\t<label for='choice_15_127_0' id='label_15_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_15_127_1'>\n\t\t\t\t<input name='input_127' type='radio' value='No'  id='choice_15_127_1' tabindex='180'   \/>\n\t\t\t\t<label for='choice_15_127_1' id='label_15_127_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_128'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_128' id='input_15_128' class='textarea medium' tabindex='181'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_129'>\n\t\t\t<li class='gchoice gchoice_15_129_0'>\n\t\t\t\t<input name='input_129' type='radio' value='Yes'  id='choice_15_129_0' tabindex='182'   \/>\n\t\t\t\t<label for='choice_15_129_0' id='label_15_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_15_129_1'>\n\t\t\t\t<input name='input_129' type='radio' value='No'  id='choice_15_129_1' tabindex='183'   \/>\n\t\t\t\t<label for='choice_15_129_1' id='label_15_129_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_130'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_130' id='input_15_130' class='textarea medium' tabindex='184'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_131'>\n\t\t\t<li class='gchoice gchoice_15_131_0'>\n\t\t\t\t<input name='input_131' type='radio' value='Yes'  id='choice_15_131_0' tabindex='185'   \/>\n\t\t\t\t<label for='choice_15_131_0' id='label_15_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_15_131_1'>\n\t\t\t\t<input name='input_131' type='radio' value='No'  id='choice_15_131_1' tabindex='186'   \/>\n\t\t\t\t<label for='choice_15_131_1' id='label_15_131_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_132'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_132' id='input_15_132' class='textarea medium' tabindex='187'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_133'>\n\t\t\t<li class='gchoice gchoice_15_133_0'>\n\t\t\t\t<input name='input_133' type='radio' value='Yes'  id='choice_15_133_0' tabindex='188'   \/>\n\t\t\t\t<label for='choice_15_133_0' id='label_15_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_15_133_1'>\n\t\t\t\t<input name='input_133' type='radio' value='No'  id='choice_15_133_1' tabindex='189'   \/>\n\t\t\t\t<label for='choice_15_133_1' id='label_15_133_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_134'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_134' id='input_15_134' class='textarea medium' tabindex='190'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_135'>\n\t\t\t<li class='gchoice gchoice_15_135_0'>\n\t\t\t\t<input name='input_135' type='radio' value='Yes'  id='choice_15_135_0' tabindex='191'   \/>\n\t\t\t\t<label for='choice_15_135_0' id='label_15_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_15_135_1'>\n\t\t\t\t<input name='input_135' type='radio' value='No'  id='choice_15_135_1' tabindex='192'   \/>\n\t\t\t\t<label for='choice_15_135_1' id='label_15_135_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_136'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_136' id='input_15_136' class='textarea medium' tabindex='193'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_15_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_15_137'>\n\t\t\t<li class='gchoice gchoice_15_137_0'>\n\t\t\t\t<input name='input_137' type='radio' value='Yes'  id='choice_15_137_0' tabindex='194'   \/>\n\t\t\t\t<label for='choice_15_137_0' id='label_15_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_15_137_1'>\n\t\t\t\t<input name='input_137' type='radio' value='No'  id='choice_15_137_1' tabindex='195'   \/>\n\t\t\t\t<label for='choice_15_137_1' id='label_15_137_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_15_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_15_138'><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_138' id='input_15_138' class='textarea medium' tabindex='196'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_15' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit' tabindex='197' \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_15' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_15' id='gform_theme_15' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_15' id='gform_style_settings_15' value='' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_15' 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