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["Weekly Behavior Card Ages 0-4"]
["Benchmark Family Services"]
[]
["Child's Name:___________________________________________________",null,null,null,null,null,"Month: ________________"]
[]
["Daily Interactions"]
["Day","Sunday","Monday","Tuesday","Wednesday","Thursday","Friday","Saturday"]
["Date"]
["Following\nDirections"]
["Eating Properly"]
["Appropriate Behavior"]
["Playing Well With Others"]
["Totals"]
["Ratings (10-9 Excellent) (8-7 Above Average) (6-5 Average) (4-3 Needs Improvement) (2-1 Unacceptable)"]
[]
[]
["Community Activities:"]
["Activity",null,null,null,null,null,"Date:"]
["Activity",null,null,null,null,null,"Date:"]
["Activity",null,null,null,null,null,"Date:"]
[]
["Medical Appointments:"]
["Dr.",null,null,null,null,null,"Date:"]
["Dr.",null,null,null,null,null,"Date:"]
[]
["Therapy Appointments"]
["Therapist",null,null,null,null,null,"Date:"]
["Therapist",null,null,null,null,null,"Date:"]
[]
["First Steps Appointments"]
["Therapist",null,null,null,null,null,"Date:"]
["Therapist",null,null,null,null,null,"Date:"]
[]
["Family Contacts"]
["Family member",null,null,null,null,null,"Date:"]
["Family member",null,null,null,null,null,"Date:"]
[]
["Allowance"]
["Amount",null,null,null,null,null,"Date:"]
[]
["Clothing","(Attach clothing and incidental receipts)"]
["Amount","______________________________________________",null,null,null,null,"Date:","___________"]
[]
["Parent Signature",null,null,null,null,null,"Date:"]
[]
["T.S.S. Signature",null,null,null,null,null,"Date:"]
[]
["Please use back of form for additional information.  Foster parents should specify changes in behavior occurred and any specific medical\nor other concerns."]
[]
["Sunday"]
[]
[]
[]
[]
[]
[]
["Monday"]
[]
[]
[]
[]
[]
[]
["Tuesday"]
[]
[]
[]
[]
[]
[]
["Wednesday"]
[]
[]
[]
[]
[]
[]
["Thursday"]
[]
[]
[]
[]
[]
[]
["Friday"]
[]
[]
[]
[]
[]
[]
["Saturday"]

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