Little Sprouts Preschool Interest Form

Little Sprouts Preschool Interest Form

A supportive environment for your child to thrive!
We're excited you're interested in our program. Little Sprouts offers preschool for children with autism, designed to provide the tools they need to succeed in kindergarten and beyond. This program will focus on academics, crafts, sensory activities, and play skills.

Classes are offered Monday through Friday, with morning sessions from 8:45 a.m. to 11:45 a.m. and afternoon sessions from 12:15 p.m. to 3:15 p.m.

Please complete the form, and someone contact you.
Child's Name

First NameLast Name
Child's DOB

MonthDayYear
Date
Parent Name

First NameLast Name
Parent Email
example@example.com
Parent Phone Number
Please enter a valid phone number.
Funding Source

Autism ScholarshipPrivate Pay
Has your child been evaluated by your school district?

YesNoIn Process
Are you interested in any additional clinic-based services? (select all that apply)

Applied Behavior Analysis (ABA)Speech TherapyOccupational TherapyPhysical Therapy
Please describe your child (behaviors, likes/dislikes, previous serivces, etc.).
Should be Empty: