AMonnie Personalized Sensory Kit Order Form

AMonnie Personalized Sensory Kit Order Form

Use this form to provide caregiver, child, sensory, safety, and order information so a personalized sensory kit can be prepared. Include the required acknowledgments before submitting.
Parent and Child Information
Parent/Caregiver Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Method of Contact
Child's First Name

First NameLast Name
Child's Age
Sensory and Communication Profile
Sensory/developmental needs

Other
Communication style

Other
What does your child enjoy?

Other
Does your child chew or put non-food items in their mouth?
Does your child enjoy chewable sensory items?
How does your child respond to loud sounds?
Would your child wear noise-reduction headphones or earmuffs?
Textures, sounds, movements, or sensory experiences the child dislikes or avoids
Items the child enjoys or the parent would like considered

Other
Favorite things (colors, characters, animals, music, activities, textures, interests)
First signs the child is becoming overwhelmed or needs sensory support
What usually helps the child calm down, regulate, or feel more comfortable
Allergies/material sensitivities?
If yes, describe allergies/material sensitivities
Order Details and Acknowledgments
Items we should NOT put in the child's kit
Anything else you want us to know before preparing the kit
How many personalized sensory kits would you like to order?
Number of kits
Acknowledgment: Kit contents may vary based on the information provided, age, safety, and item availability
Acknowledgment: Sensory items are not medical treatment, and caregiver supervision is my responsibility
Acknowledgment: The information provided is accurate and may be used to prepare and communicate about the order
Payment and order processing details are handled separately in this section

My Products

Sensory Kit

A personalized sensory-support kit created around your child’s individual age, preferences, and sensory needs. Each kit includes carefully selected sensory tools to support comfort, calm, communication, and everyday sensory experiences.

$35.00

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

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AMonnie Personalized Sensory Kit Order Form

Parent and Child Information

Sensory and Communication Profile

Order Details and Acknowledgments

My Products