2019 BADP Child Application
Tell us about your child
Your child's first and last name? *
Your answer
Which age group are you interested in this summer? *
For how many weeks do you want to attend? If less than 6 weeks, please indicate which dates will be missed? *
Gender? *
Your answer
Date of birth? (month/day/year) (e.g. 7/12/2010) *
Your answer
Age by June 1st? (years and months) (e.g. 7.8) *
Your answer
Current grade in school this year? (e.g. 2nd) *
Your answer
Number & sibling order? *
Your answer
What is his/her diagnosis? *
Required
Does your child want to attend BADP? If so, please explain why? If not, please also explain why. This will better prepare us for the intake. *
Your answer
Please describe in detail his/her social difficulties in structured settings, such as the classroom, organized sports, etc...? *
Your answer
Please describe in detail his/her social difficulties in unstructured settings, such as gym, recess, play-dates, birthday parties, after-school activities, etc... *
Your answer
What are the typical triggers that make your child upset? *
Your answer
What is an effective way to intervene when your child becomes upset? *
Your answer
Do you use time-outs? If so, how easily does your child take a time-out? Is there every any resistance? If so, why kind of resistance? Please be specific. If you don't use time-outs, why not? What do you do instead when he/she is non-compliant, breaking rules or acting unsafe? Please be specific. *
Your answer
What group activities does your child do after school or on the weekends? sports, gymnastics, robotics, etc. Are there any specific social issues you notice? *
Your answer
What services is your child currently receiving outside of school? (Check all that apply) *
Required
Describe his/her academic difficulties that you want him/her to improve over the summer? *
Your answer
Briefly describe his/her strengths? *
Your answer
What incentives, if any, motivate your child (e.g., charts, points, toys, money, food, TV, video games, etc...) *
Your answer
What did your child do last summer? Did he/she attend camp? Please describe any notable issues that would help us for this summer? *
Your answer
Any current or recent (in past 6 months) history of aggression to kids (peers, siblings, etc..) or adults (parents, teachers, etc...), running away or destruction of property? *
Your answer
Any current or history of sexual abuse or trauma with your child or in the family? *
Your answer
Any current or history of sexualized behaviors with your child? *
Your answer
Does your child have any self-care issues (e.g., toileting, changing clothes, etc...) *
Your answer
Does your child have any medical or physical problems? Allergies? Food issues? Major dietary restrictions? *
Your answer
Does he/she take medication? If yes, please describe with names of medications and reason for taking the medication. *
Your answer
School Name & City and State *
Your answer
Does your child have an IEP? If yes, what is the classification? *
Your answer
What services does he/she currently receive at school? *
Required
Parent or Legal Guardian (1) Full Name *
Your answer
Street, City, State *
Your answer
Home tel *
Your answer
Cell tel *
Your answer
Email *
Your answer
Parent or Legal Guardian (2) Full Name
Your answer
Street, City, State
Your answer
Home tel
Your answer
Cell tel
Your answer
Email
Your answer
Custody Arrangement *
Any important family issues we should know about? *
Your answer
Full name of the person completing this application *
Your answer
How did you hear about us or by whom were you referred? *
Your answer
If your annual house-hold income is $150,000 or less, we offer a 25% reduction in the program tuition only. We require a copy of the first page of your most recent 1040 tax return or letter from your accountant. Do you qualify for this? **Can I pay in advance to secure the discount before we’ve been accepted? Yes. Even if you are not done with your application, interview or have been accepted, you can pay in advance to secure one of our 2 discounts before 4/1. However, if you are not accepted, you will be refunded what you paid minus $500. If you are accepted, there are no additional fees. *
Are you interested in private chaperoned transportation for an additional $650 per week? (please see website for details) *
Are you interested in early drop-off for an additional $200 per week? (please see website for details) *
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