LTL SPECIAL NEEDS FORM

LTL Special Needs Information Form

Abide and Belong-Rooted in Christ, Embraced by Community
Please help us better understand your child's needs so that we can give them the best possible experience at LTL! We will do everything we can to make the necessary adjustments and accommodations in whichever classes they are interested in taking.
Child's Name:
Child lives with:
Guardian Email Address:
example@example.com
Father/Guardian's name:
Mother/Guardian's name:
Child's primary health concerns we should be aware of including any Special Needs diagnosis you would like to share:
Allergies: drugs, food, other:
Please list siblings of child who will also be attending:
THE EMERGENCY CONTACT TO CALL ON CAMPUS IF THE CHILD IS IN NEED OF MOM/DAD DUE TO A TRIGGER TYPE SITUATION (At least one contact must be provided)
Name and Number:
Relationship:
If able, please share examples of behaviors that we may see in class so that we can avoid any triggers or escalations. See examples below.

Usually Plays alone, but sometimes in groups

Adapts to new situations with difficulty

Sometimes hits sibling. Might attempt to run away from classroom to find me.

Responds to corrections with difficulty.
Behaviors:
Does your child have any environmental triggers such as loud noises, large groups, stimuli sensitivity?
My child is best comforted by and can use the following things as coping strategies:
My child lets someone know what he/she wants or needs by?
What type of play activities does your child enjoy and/or participate in?
My child becomes upset when/or does not enjoy:
We have found at LTL that some students function better with a 1:1 aide to assist with learning needs in an inclusive environment. Would you be comfortable with having a 1:1 aide with your child if the team is able to offer this accommodation?
Does your child need your presence to participate in activities? Is it a goal of yours to have your child participate without your presence in their classroom?
GOALS: Can you describe what success means for you and your child here at LTL? Example: remains in class for an allotted time, refrains from specific behavior, etc.
Are there any additional concerns not already addressed?
Permission/Authorization agreement:

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY AND SIGN IN THE DESIGNATED SPACE INDICATING THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE PROVISIONS:

I have fully disclosed to Learn Together Lowcountry all pertinent facts about my child's special needs and accept full responsibility for missing information.

I will supply special foods, drinks, snacks for my child as necessary.

I or a designated adult family member will remain on LTL campus during the time my child is participating in any ministry/event/program.

I have read and initiated the above permission/authorization statements and agree to the terms designated in each.
Signed

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Abide and Belong proudly sponsored by

Madison's Port Royal

Travelers Rest Counseling Associates

Physical Aggression Policy

At Learn Together Lowcountry, we are committed to inclusivity for the homeschool special needs community. We strive to accomodate and adjust so each student feels welcome, included, and enjoys their classroom experience.

To support this, we offer a sensory room and program for:
- Needed breaks
- Sensory bags in each classroom
- 1:1 aides for students requiring individualized attention
- Frequent communication between parents, students, teachers, and the Special Needs Director.
- Recommendations for resources outside of LTL from Special Needs Director
While our primary goal is to prevent and avoid escalation that could lead to physical aggression, we recognize that such situations may occasionally arise. To ensure the safety of all students, teachers, and volunteers, we have established the following 3-strike policy:
- First Incident:
  - If a student displays any form of physical aggression, including, but not limited to:
    
    biting
    
    hitting
    
    throwing objects directed at peers and staff
  - The Special Needs Director will contact the parent or guardian on camps immediately. The parent will be required to remove the student from campus for the remainder of the day.
  - The student may return the following week after a meeting with the Special Needs Director.
- Second Incident:
  - If physical aggression occurs again, the student will be required to leave campus for the day.
  - Upon return, a parent or guardian must always accompany the student, particularly in the sensory room. The Special Needs Director will collaborate with the parent/guardian to determine the duration of this requirement.
- Third Incident:
  - If a third incident of physical aggression occurs, the student will no longer be able to attend classes that semester, but will be able to discuss reevaluation and a plan for future semesters.
There are proactive steps taken that we have found successfully prevent any of these incidents from occurring. Partnering with parents and guardians is essential to success and will be consistently utilized. Incidents will be documented, reviewed, and shared with parents to ensure transparency, consistency, and fairness.

If you have any questions or concerns about this policy, please to not hesitate to contact our Special Needs Director, Mia Henke, at mia@learntogetherlowcountry.org

I understand this policy.
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LTL Special Needs Information Form