|  |  |  | 1. | Are you a single parent or otherwise lack time to spend with your child? | 
			
				|  |  |  | 2. | Are you desperate for help from outsiders to help care for your child? | 
			
				|  |  |  | 3. | Are you raising your child in a broken or unstable home? | 
			
				|  |  |  | 4. | Is there someone in your life who has an unusual, "too good to be true" interest in your child? | 
			
				|  |  |  | 5. | Does someone give your child gifts, especially gifts they seem to know kids really want (examples are a cell phone, paid for by themselves, or an ipod)? | 
			
				|  |  |  | 6. | Does your child receive mail, gifts, or packages from someone you don't know or more often than special occasions? | 
			
				|  |  |  | 7. | Does the person show up, without a child, at child-oriented events and locations? | 
			
				|  |  |  | 8. | Does the person offer to help, or always have reasons that will leave them alone with your child? | 
			
				|  |  |  | 9. | Does your child spend a lot of time online, especially at night? | 
			
				|  |  |  | 10. | Does your child use an online account that is in someone else's name? | 
			
				|  |  |  | 11. | Have you found pronography on your child's computer? | 
			
				|  |  |  | 12. | Does your child receive phone calls from men you don't know or make calls to numbers you don't recognize? | 
			
				|  |  |  | 13. | Does your child quickly change the screen or turn off the monitor when you come into the room? | 
			
				|  |  |  | 14. | Is your child withdrawing from the family? | 
			
				|  |  |  | 15. | Does the person always seem to have children around, get involved, or volunteer to work with children, even if they don't have children? | 
			
				|  |  |  | 16. | Does the person acquire "toys" that are attractive to children and invites children to use them (examples are video games, a boat, jet skis, a hot tub, or pool)? | 
			
				|  |  |  | 17. | Does the person sometimes try to help your child solve problems, stepping into or usurping parental authority? | 
			
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				| Total 'Yes' |  |  | (out of 17 possible) | 
			
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				| Interpretation |  |  | 
			
			
			
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