Visit/Contact Report for Active Volunteers

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Thank you for volunteering with the It Takes a Village! Please submit this very quick form after each contact with your family as well as each home visit. If you are concerned about your family or need support please call or text Tara at (413) 204-2246 or Tara@HilltownVillage.org

Email *

Volunteer Name (First and Last) *

Home Visit Family's Name (same as on profile sent) *

Date of visit, email, text or phone call *

YYYY

How many visits/contacts are you reporting for? If more than 1, please list the other dates. *

Please make it a habit of completing a visit report after each visit. it is important for It Takes a Village and our supporter to get a sense of what is happening in the visits. However, if you forget to complete a visit, feel free to combine visits and write a longer narrative. Thanks!

What is the total number of visits you have made, if known?

What types of support did you provide for your Village family during this visit? *

Check all that apply

Errands

Food preparation or made a meal

Talked on the phone/offered a friendly ear

Companionship

Laundry Assistance

Went for a walk

Referred to an educational resource (website, book, article, Resource Kit)

Referred to a local resource (agency, provider, Mother's Group, Village Closet)

Baby care

Care of older children

Dishes

Other Housework (light cleaning, taking out trash, etc)

Accompanied family out to an appointment or in the community

Taught a skill (diapering, bathing, using a carrier)

Village Closet run

Brought by a coffee or tea

Had a picnic

Other:

Required

Things we report on:

Increase in knowledge of community resources including social support, health and educational resources

Increase in social connections with other Hilltown families

Increase confidence in parenting skills, including infant care, discipline and handling emergencies

Increase in skills and greater understanding of positive parenting

Increase in knowledge about child development.

What were the highlights of your contact with your family? *

Anything from the list above? How is the family? What does Tara need to know to better understand how visits are going? What specific skill, if any, did you teach? What specific resource did you refer to, if any? Do you feel visits are having an impact? if so, how?

Did your family say anything that we can quote? *

Even something as simple as "This really made me feel better today!" shows our supporters the real-life impact of your work!

How are YOU doing? *

This is very important. How are YOU feeling about your relationship with your family? Do you or your family have any concerns or need assistance? How can Tara support you?

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