Please complete this form with as much detail as possible so that our staff will be able to understand the level of support your child may need. A member of our staff will be in contact with you shortly. We want to make sure your child will SHINE at Creekside.
Street Address Line 2
State / Province
Postal / Zip Code
Tell us about your child:
How does your child ambulate?
What are your child's communication needs?
Utilizes a communication device
Please explain how your child communicates. (Give examples of gestures or signs for certain words)
Please explain how your child best interacts with others.
Does your child read?
How are your child's fine motor skills? (select all that apply)
Able to write with assistance
Able to color with assistance
Able to write independently
Able to color without assistance
Is your child subject to seizures?
If your child is subject to seizures, a seizure protocol should be on file with Creekside Church before attending.
Does your child wander/run from teachers/classroom?
How does your child adapt to change? (Change in seating or schedule)
Does your child have any environmental sensory sensitivities? (sounds, lights, etc.)
Please list any allergies.
Please specify your child's toilet/hygiene needs:
Independent in the restroom
Help needed in restroom
What are your child's favorite motivators and/or calming activities?
What are some activities your child enjoys?
What activities does your child least enjoy?
Should be Empty: