Questionnaire (2 copies, to be filled out by safe guard and offender separately)

Nurturing ways take on many forms, some more apparent than others. Often being nurturing is intergenerational and it's forms passed down from grandparents, to parents and eventually continued generation by generation without thought or question. On the following questionnaire please check all items where this has occurred as a way of treating children within the family. If you have seen your parents use any of these forms place a "P" in the column; if you use one of the following forms place a "S" in the column.

Provide Emotional Security:

Talk and act so children feel safe and comfortable expressing themselves

Be gentle

Be dependable

Provide Physical Security:

Provide food, shelter, clothing

Teach personal hygiene and nutrition

Monitor safety

Maintain a family routine

Attend to wounds

Provide Discipline:

Be consistent

Ensure rules are appropriate to age and development of child

Be clear about limits and expectations

Use discipline to give instruction, not punish

Give Time:

Participate in your children's lives: activities, school, sports, special events and Days, celebrations, friends

Include your children in your activities

Reveal who you are to your children

Encourage and Support:

Be affirming

Encourage children to follow their interests

Let children disagree with you

Recognize improvement

Teach new skills

Let them make mistakes

Give Affection:

Express verbal and physical affection

Be affectionate when your children are physically or emotionally hurt

Care for Yourself:

Give yourself personal time

Keep yourself healthy

Maintain friendships

Accept love

Trust and Respect:

Acknowledge children's right to have own feelings, friends, activities and opinions

Promote independence

Allow for privacy

Respect feelings for other parent

Believe your children

Signature: _____________________Date:_______________