Old Pueblo Gymnastics - Adaptive Gymnastics Interest Form

  • Adaptive Gymnastics Interest Form

  • Parents - please provide the following information. This information will assist our occupational therapists in determining an appropriate placement for your child. We will be contacting you soon to advise you of the next steps!

  •  -
  • Gender*
  • Child's Date of Birth*
     - -
  • I am interested in:
  • Does your child have difficulty with loud noises and/or crowded places?*
  • Does your child avoid being touched or have aversions to being touched by others?*
  • Does your child get frustrated easily?*
  • Does your child have difficulty with running away or leaving a group during structured tasks?*
  • Does your child have any mobility limitations?*
  • Does your child have difficulty with coordination and learning new skills?*
  • Does your child seek out intense movements (i.e. crashing, jumping, running) or seem to be in constant motion?*
  • Does your child avoid or hesitate doing certain types of movement (i.e. going up stairs, sliding, swinging, etc.)?*
  • Child's Availability for Classes or Private Lessons (please check any your child is available for):
  • Should be Empty: