• FOUR DIAMONDS

    NEEDS ASSESSMENT FORM

    The mission of FOUR DIAMONDS is the pursuit of the following principles:

     

    * Commitment: FOUR DIAMONDS wants to inspire social friendships, strong interpersonal skills, and instil a sense of hope in the future.

    * Responsibility: The focus of FOUR DIAMONDS is to empower children in establishing goals and following through on commitments.

    * Possibility: FOUR DIAMONDS wants to expand the perspective of children to make them aware of all life's possibilities.

    * Support: An individual is dramatically influenced by their support system. FOUR DIAMONDS wants to surround these children in a caring, inclusive safe supporting environment.

    We believe in these four principles (4 diamonds) that help to provide healthy growing relationships in the development of all our children's life.

     

     

  • THE PROCESS:

    1. The purpose of this assessment is to determine what level of care your child requires and to make sure we can provide a safe, secure and fun environment so they can be included into a "mainstream programme." Four Diamonds is for neurodivergent children.  The programme is NOT designed for children with high needs physical/intellectual disabilities.

    2. Please answer all the questions - Everything with asterisks * must be completed

    3. Please be as detailed as possible in your form as this can delay our assessment if we have to come back to you asking for further information.

    4. Due to increased enquiries please allow up to 20 working days for your assessment to be completed by our team.

    5. Contact will be made via email.

    6. A visit maybe required by yourself and your child, an appointment will be sent to your via email

    7. A client number will be allocated to your child upon assessment approval which will let you book your child into Four Diamonds Programmes. Without this number your booking will not go ahead.

  • Your preferred centre location:*
  • Please select the sessions you are interested in for this child*
  • Sex of Child*
  • Ethnicity Group your child most identifies with (this is collected for statistics purposes)


  • DISABILITY - PLEASE TICK ALL THAT APPLY TO YOUR CHILD*

  • ADHD Level*
  • ADHD - Medication*
  • ADHD - does a supervisor need to administer your child's medication?*
  • FASD Level*
  • ASD Level*
  • ODD Level*
  • GAD Level*
  • GDD Level*
  • OTHER Level*
  • SENSORY - PLEASE SELECT ALL THAT APPLY TO YOUR CHILD*

  • SOCIAL - PLEASE SELECT ALL THAT APPLY TO YOUR CHILD*

  • PROCESSING - PLEASE SELECT ALL THAT APPLY TO YOUR CHILD*

  • BEHAVIOUR- PLEASE SELECT ALL THAT APPLY TO YOUR CHILD*

  • OTHER - PLEASE SELECT ALL THAT APPLY TO YOUR CHILD*

  • MY CHILD RESPONDS WELL TO:*

  • ACTIVITIES FOUR DIAMONDS CURRENTLY PROVIDE - MY CHILD ENJOYS:*

  • Does your child currently have a teacher aide at school*
  • How long does your child have their teacher aide during a normal day*

  • Does your child require 1 to 1 supervision? (this means does your child need to be supervised the whole time - they cannot be left alone)*
  • Has your child attended another after school or school holiday provider before?*
  • DO YOU CURRENTLY RECEIVE FINANCIAL ASSISTANCE FOR YOUR CHILD*

  • Date Signed*
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