Daily Little Adventures—New Client Intake Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
What space(s) will DLA be assisting you with?* This field is required.Select all that apply
4
Who will be using the space?* This field is required.Input separate description (info/age) for each person who will utilize this space:
5
Why do you want DLA’s help?Select all that apply:
No Time! I’ll pay for help!
Not my kind of project…
Too much stuff/ I’m overwhelmed!
Need help maximizing my budget!
Age gap between kids is hard…
Other reason
6
What are your goals with this space as the parent/caregiver or provider?Select all that apply:
Encourage independent play
Opportunity for teaching/learning
Toy organization
Developmentally supportive play
Active play
Foster creativity
Invite family/caregiver interaction
Specific therapy goals
Separation of space
Reduce screen time
Other
7
Your Kid(s) Go-To Activities* This field is required.Select all the categories of play that your kid(s) typically engage in:
Physically Active
Sports
Academic Tasks
Puzzles/Games
Reading
Transpo (Trains, Cars, Planes, etc.)
Building (Blocks/Tiles/Legos)
Make Believe/Pretend
Music/Singing
Arts & Crafts
Technology
Video Games
OTHER (explain later)
8
What furniture/structures do you already have that you want to keep?* This field is required.i.e., bunk bed, dresser, ceiling fan, chair, etc.
Huge
Large
Normal
Small
Ok
Ok
9
Storage Space* This field is required.Does this space have additional storage (i.e., closet)?
Please Select
Please Select
I have a separate storage space (closet)
I do NOT have a separate storage space
Select one
10
Approved Space Changes* This field is required.What can we do?
Paint
Furniture/Built-Ins
Hanging on walls
Lighting
Window Coverings
Flooring
11
Describe Your Space Aesthetic* This field is required.Are you looking to stay away from or steer towards any particular style or decor choices?
Huge
Large
Normal
Small
Ok
Ok
12
What type of service do you think you may need?* This field is required.It’s ok if you’re not sure—we will confirm your service during our consultation.
E-HELP ME (E-Design + Shopping List)
TAKE THE WHEEL (Full Design + Execution)
13
Ideal TimelineIdeally, when would you like to complete this project?
Date
Year
Month
Day
14
Anything else you would like us to know about this space?Helpful information that may impact design or function
Huge
Large
Normal
Small
Ok
Ok
15
File UploadUpload any current pictures of your desired space(s)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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FREE Launch Consultation* This field is required.Select a 30 minute meeting slot to launch your project
Should be Empty: