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New Participant Questionnaire

Dear Parent/Guardian:

The KIDnections Group is excited to provide your child with fun experiences and social opportunities at North Olmsted Recreation Center. Please take some time to fill out the following interview. Although it seems lengthy, the more information we have with regard to your child’s abilities and needs, the better we will be able to tailor this social experience to your child. Please complete and submit this form prior to the workshop. Thank you for your time and we look forward to meeting your child!

 

Guardian Information
School/Therapy Information
Please indicate your child’s school placement:
Please indicate your child’s school placement:
Name of School
If "Other" is selected, please elaborate.
At the school listed above, please describe the type of classroom your child is a part of.
Please indicate the types of therapy your child receives, both at school and/or privately.
If you selected "Other", please elaborate.
Medical Information
Please list any allergies your child may have, especially food-related allergies:
Please list any additional diagnosis, other than your child’s diagnosis of Autism, that might be pertinent to this experience.
Are there any other medical concerns or issues that you feel are important to share?