• Little Palms Sensory Session Intake

    Welcome to the Palm & Play Session Intake FormThank you for booking a Palm & Play sensory enrichment experience! This form is intended for daycares, afterschool programs, community organizations, and other group programs that have already scheduled their session and submitted payment. Your responses will help our team safely prepare, personalize, and tailor the experience to your participants. Please answer each question as completely and accurately as possible, including any allergies, sensory needs, accommodations, or special requests. Please provide the first name of every participant attending the session. Names may be used to personalize activity materials, worksheets, labels, or take-home items. Please make sure your participant list is accurate and matches the number of participants included in your booking. After your intake form is submitted and reviewed, a Palm & Play team member will contact you by email or phone to confirm the final session details. We look forward to creating an inclusive, engaging, and memorable experience for your group!Inclusive Play. Limitless Potential. 🌴

  • Organization Information

  • Format: (000) 000-0000.
  • Best Method of Contact*

  • Booking Information

    Session REQUEST
  • Preferred Session Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Alternate Session Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Preferred Time Slot*
  • Location Type

  • Featured Activity Choice

    Choose one featured activity. Custom options may be discussed after intake review; full actitity list can be provided upon inquiry. Palm and Play is very flexible we accept request, pinterest request. Remember this is a facilitated services provided from us to you.
  • Activity

  • Additional notes:

    Activity selections are requests and are not guaranteed until reviewed and confirmed by the Palm & Play team. Final activities and available themes will be determined based on participant ages, abilities, group size, session length, allergies, sensory needs, and material availability.
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  • Participants

    Please complete this roster to the best of your ability. If your participant list has not yet been finalized, please download and save this form, then complete and submit it once the information becomes available. Be sure to include each participant’s first name and any known allergies, sensory needs, restrictions, or accommodations.
  • Downloadable PDF Participant Roster Form
  • Participant roster
  • Will an additional roster be sent separately?*
  • Any known allergies?*
  • Restriction areas
  • Communication supports needed

  • Staffing Present During Session

  • Name of staff member(s) present during session
  • Staffing acknowledgment*

  • Accommodations & Safety

  • Space available for setup*
  • Table and chair availability
  • Sink access on site
  • Bathroom access on site
  • Parking/Loading
  • Electrical Outlet
  • Floor space

  • Media Permission

    Photo/ Video
  • Media permission*

  • Acknowledgement +Booking Agreement

    Please review and initial each acknowledgement before submitting this intake form. This helps Palm and Play prepare a safe, organized, and developmentally appropriate sensory experience for your program.

  • Signature & Submission

  • Date Submitted*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Session Date Acknowledgement*
  • Should be Empty: