• REGIONAL CENTER PARTICIPANT INTAKE & CLASS PLACEMENT FORM

  • Gymnastics | Tumbling | Movement Adventure | Mind & Motion Adventure
  • This brief intake helps us understand your child's current abilities, support needs, and experience in group settings so we can recommend the safest and most appropriate class environment. It is not a medical or diagnostic evaluation.

  • 1. CHILD & FAMILY INFORMATION

  • Your Regional Center*
  • Is your child currently enrolled in the Regional Center Self-Determination Program (SDP)?*
  • If yes - Which Financial Management Service (FMS) provider do you currently use?
  • Which program(s) are you interested in?

  • 2. CURRENT GROUP CLASS EXPERIENCE

  • Is your child currently participating in a mainstream group class or activity?*
  • Approximately how many children are in that group?
  • How does your child usually participate in that group?

  • 3. COMMUNICATION & GROUP PARTICIPATION

  • How does your child communicate? (Check all that apply)*
  • Your child can usually: (select all that apply)*
  • Does your child need frequent 1:1 prompting to participate safely or remain with the group?*
  • Stars Gymnastics LLC | 410 N Azusa Ave., Covina, CA 91722 | Office@Stars-Gymnastics.com

  • 4. MOVEMENT, SAFETY & SUPPORT NEEDS

  • Which best describes your child's movement abilities? (Check all that apply)*
  • Does your child currently have any of the following safety support needs?*
  • During a group class or activity, does your child typically remain with the group and within the designated activity area?*

  • 5. SUPPORT LEVEL & CLASS PLACEMENT

  • Does your child currently receive support from an aide, parent, therapist, or other 1:1 support person during group activities?*
  • Based on your child's current group experiences, what level of support seems most successful?*
  • Would a parent/caregiver be available to assist during class if needed for safety or successful participation?*
  • What assistance does your child need when he/she needs to use the restroom?*

  • 6. Tell us more

  • LAST QUESTION

    Make scheduling quicker and easier by providing us with days/times that can work for you.
  • What days & time frames you can be available for your weekly scheduled classes? These are time ranges & not the exact length of any class. Check all that apply.
    Rows

  • What happens next?

  • Our staff will review this information so they'll be ready for your in person 
    The next steps are for you to create an account and schedule your in person meeting.  Follow the instructions below.  You will receive a copy of this in your email. 

     

    1. Create a Fullout Account
    Fullout is our registration system. You must have an account to signup for any classes or activities.    Use the "How to" instructions by clicking here. 

     

    2. Schedule a 30-Minute In-Person Consultation & Child Evaluation - Using the Fullout app.   Use the "How to" instructions by clicking here.

    One-time appointment fee: $18.00

    This fee covers the dedicated time our staff spends meeting with your family, interacting with and observing your child, and evaluating which class environment and level of support may be appropriate.

    During this appointment, we will:

    Meet and interact with your child
    Discuss your goals, concerns and priorities
    Introduce your child to the gym environment
    Try age-appropriate movement and gymnastics activities
    Observe communication, participation and response to instruction
    Consider the amount of prompting or assistance your child may need
    Discuss which class environment may provide the best starting point
     

    Depending on your child's needs, recomendations may include:

    Traditional Group Class • Small-Capacity Class • 1:1 Individualized Lesson

    If a traditional recreational class appears to be an appropriate option, we may schedule a free trial class before enrollment.

     

     

     

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