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Family Referral Form

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About
Newsletters
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Courses & Events
Get Involved
Contact Us
Family Referral Form

Circle of Security Course Evaluation

As part of your course attendance, we require you to complete this short questionnaire. All answers will remain confidential.

Circle of Security Course Evaluation Form

Please select which evaluation stage you are completing (pre- or post-course)

I use a variety of ways to play and interact with my child.

Always

Most of the time

Sometimes

Rarely

Never

I can identify milestones my child should achieve in their development.

Always

Most of the time

Sometimes

Rarely

Never

I comfort my child when they are upset.

Always

Most of the time

Sometimes

Rarely

Never

I speak calmly rather than raise my voice or yell at my child.

Always

Most of the time

Sometimes

Rarely

Never

My child interacts well with other children.

Always

Most of the time

Sometimes

Rarely

Never

My child and I get along.

Always

Most of the time

Sometimes

Rarely

Never

My child comes to me for comfort/ reassurance.

Always

Most of the time

Sometimes

Rarely

Never

Are there any special requirements specific to your learning that you would like your facilitator to know? (short answer)

I use a variety of ways to play and interact with my child.

Always

Most of the time

Sometimes

Rarely

Never

I can identify milestones my child should achieve in their development.

Always

Most of the time

Sometimes

Rarely

Never

I comfort my child when they are upset.

Always

Most of the time

Sometimes

Rarely

Never

I speak calmly rather than raise my voice or yell at my child.

Always

Most of the time

Sometimes

Rarely

Never

My child interacts well with other children.

Always

Most of the time

Sometimes

Rarely

Never

My child and I get along.

Always

Most of the time

Sometimes

Rarely

Never

My child comes to me for comfort/ reassurance.

Always

Most of the time

Sometimes

Rarely

Never

This service listened to me and understood my issues.

Agree

Tend to agree

Neither agree or disagree

Tend to disagree

Disagree

I am satisfied with the services I have received.

Agree

Tend to agree

Neither agree or disagree

Tend to disagree

Disagree

I am better able to deal with the issues that I sought help with.

Agree

Tend to agree

Neither agree or disagree

Tend to disagree

Disagree

If there are any further comments, suggestions or feedback you have, please feel free to add them to the box below. This information assists us to improve our services to the community.

We'd love to hear from you - get in touch today

Ph: (02) 4340 1585
Email: ccfss@ccfss.com.au
21 Old Mt Penang Rd Kariong NSW 2250
PO Box 7125 Kariong NSW 2250

At Central Coast Family Support Services we acknowledge the traditional custodians of this land, the Darkinjung people. We acknowledge the strong kinship networks and positive parenting practices that Aboriginal people have successfully used for tens of thousands of years before us, and continue to use today.

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Family Support Program

Family Support Program

Early Intervention Support

Young Parent Program

Child & Family Services​

Grandparents & Grandchildren

Child & Family Services

Children with Additional Needs

Circle of Security Course Evaluation

We'd love to hear from you - get in touch today

Family Support
Program

Young Parent
Program

Child & Family
Services

Child & Family
Services