Kids Cafe Monthly Report Questions
Site______Month/Year ______
Reports are due to the Regional Food Bank by the 1ST of each month. Please answer all questions!
If you need more space, please use the back or an additional page.
1. Did you have any health or nutrition lessons this month?
□ Yes
□ No
If yes, what topics did you cover? Please describe.
2. Did you give information about Sooner Care to any parents?
□ Yes
□ No
If yes, how many families received the information?
3. What physical activities did the children participate in? Include games, sports, and other activities that got the children moving.
4. Did you provide educational activities for the children this month? Check all that apply.
□ Tutoring
□ Reading
□ Computer activities
□ Homework assistance
□ Other:
5. Have you noticed any emotional disturbances in the children?
□ Yes
□ No
If yes, describe any referrals you made.
6. Have parents expressed any concerns about their children to you? If so, did you refer the family for help or counseling?
7. Did you provide activities that helped develop any of the following skills?
□ Communication skills
□ Conflict resolution
□ Respect for others
□ Cooking
□ Manners
□ Social skills
□ Problem solving
□ Cultural education
□ Spiritual education
Please give details. Explain:
8. Did you have any Parents’ Club meetings this month?
□ Yes
□ No
If yes, what did you do at the meeting?
9. Did you have any lessons on the hazards of the following?
□ Drugs
□ Alcohol
□ Smoking
□ Premature sex
□ None of the above
Tell us about the lessons.
10. Tell us about any success stories you had this month? (Ways Kids Cafe made a difference in child’s life)
______
______
______
______
Return report to the Regional Food Bank of Oklahoma, attention Devin Schroeder, by the 1ST of the month.
Fax to 405-688-6447 or email to
Page 1 of 2