Home Visit Form
Details of Homely Activities of Students
Visit Information
Visit Date
Teacher Name *
Student Information
Student Name *
Class *
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Section *
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Roll No *
No. of Siblings
Father's Name
Mother's Name
Occupation
Contact
Address
Student Photo
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Student Activities
Where does the student do reading homework?
Where does the student do writing homework?
What is the student interested in?
Behaviour With Family
Response To Guests
Keeps Things In Original Place?
Select
Yes
No
Sometimes
Eats Junk Food?
Select
Yes
No
Sometimes
Mobile / Laptop Usage
TV Watching
Assists Household Activities?
Select
Yes
No
Sometimes
Washes Personal Clothes / Dishes?
Select
Yes
No
Sometimes
What does the student say about school, teachers and friends?
Guardian Information
Does the guardian appreciate the child?
Select
Yes
No
Sometimes
Does the guardian involve the child in social activities?
Select
Yes
No
Sometimes
Does the guardian keep the child informed about family matters?
Select
Yes
No
Sometimes
Does the guardian give time to the child?
Select
Yes
No
Sometimes
Does the guardian attend guardian programs?
Select
Yes
No
Sometimes
Does the guardian encourage the child despite simple mistakes?
Select
Yes
No
Sometimes
New Student Information
New Student Name
New Student Address
Remarks
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