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Divergent Fitness Registration
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Email *
Trainee's Name *
D.O.B *
Home Address *
Primary Number *
Primary E-mail *
Does the trainee have a formal diagnosis? If so which one(s)?
Are there any physical limitations we need to be aware of? Previous injuries or motor difficulties that impact purposeful physical movement?
How would you describe his/her gross motor skills?
Does the trainee participate in APE, PE or receive OT or PT? Has the trainee participated or currently participating in any physical conditioning programs or other sports programs?
Describe trainee's learning style. Do they respond more to auditory, visual, kinesthetic or combination of two or more cues?
What are his/her preferred activities?
Does the trainee have any sensory processing difficulties that we need to be aware of?
Does the trainee benefit from a communication partner or behavior support specialist? Please list behavior/communication specialists working trainee.
Can you describe trainee's receptive and expressive communication?
Are there any triggers for regulation difficulty we should be aware of when working with trainee?
What are some of the goals you would like the trainee to accomplish by participating in this exercise program? Are there any areas in particular that you would like us to focus on? Are there any IEP goals that we can address?
List any other information that might be important in getting to know the trainee and his/her unique qualities:
How did you hear about Bay Area Divergent Fitness?
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