THSC CONVENTION SPECIAL BUDDIES PORTFOLIO

The Special Buddies Program (SBP) is available to individuals with special needs on a case-by-case basis and while space is available. The SBP reserves the right to recommend other options, possibly including the Children’s Program, if an individual does not fall within the parameters of the SBP. For security purposes and because of the personalized care offered through the Special Buddies Program, please email a recent picture of your loved one to specialbuddies@thsc.org. In the subject field, please put “SBP 2018” followed by your loved one’s last name.

What is the individual's name?
Your answer
Program desired?
What is the individual's birthdate?
Your answer
What is the individual's t-shirt size?
What is the individual's current weight?
Your answer
What is the individual's age chronologically?
Your answer
What is the individual's age developmentally?
Your answer
What is (are) his/her special needs?
Your answer
What is his/her father's name?
Your answer
What is his/her mother's name?
Your answer
What is your email address? *
(Required for convention confirmation.)
Your answer
Please answer the following questions as thoroughly as possible. Can you describe your loved one’s special need? If so, what is it? Feel free to include your own conclusions.
Your answer
My loved one best responds to:
Please describe your loved one's special needs by choosing from the following options.
My loved one’s normal disposition is:
My loved one's favorite toy or activity is:
Your answer
My loved one REALLY does NOT like to:
Your answer
My loved one likes:
My loved one also likes:
Behavior issues:
When my loved one is unhappy, the following things might calm him or her:
Your answer
Method of communication:
Social Behaviors: Does your loved one have any socially inappropriate behaviors? If yes, please describe.
Your answer
What specific words or hand signals do you use to redirect your loved one?
Your answer
Special feeding issues: (*Parents bring necessary supplies)
*NOTHING with PEANUT INGREDIENTS is permitted.
If you selected "Food Allergies" above, please list allergies here.
Your answer
Toileting:
(Parents bring necessary supplies)
Mobility:
IS YOUR LOVED ONE A RUNNER?
Medical: Does your loved one have seizures?
Your answer
Are they life-threatening?
Your answer
Medication allergies:
Your answer
Is there anything else that would be useful for someone who cares for your loved one to know?
Your answer
Medical Release / Hold Harmless Agreement *
Mother’s Name or Legal Guardian:
Your answer
Father's Name or Legal Guardian: *
Your answer
Cell phone (during Convention) *
Your answer
Cell phone (during Convention)
Your answer
Medical Agreement *
We, the undersigned (parents or guardians), by signing digitally below, agree to hold harmless from any liability the Texas Home School Coalition Association, or any other participants, planners, volunteers, or persons involved with the 2018 Children’s Program, Preteen Program, Toddler Play Area and/or Teen Staff Program arising from injury or sickness sustained by my child(ren) during their participation in this year's event. In addition, we agree to release our child(ren) to any needed first aid or emergency treatment that appears to be necessary and understand that we will be contacted as soon as is reasonably possible in the event of any serious injury to our child(ren). Please sign.
Required
Date: *
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We have carefully read this release of liability and medical consent form, understand it, and willingly agree to its contents. *
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