Spectrum Insights New Student Form
Name of student *
Your answer
Age *
Your answer
What programs are you interested in? *
Required
Any Allergies
Your answer
Medical concerns
Your answer
Behavior Issues that we should be aware of *
Your answer
Can he/she function independently in a group setting, 5-20 students (does not need one to one care) *
Required
Sensory issues that may affect your child’s day
Your answer
Goals for your child
Your answer
Please note our coaching and groups are not appropriate for any aggressive behaviours or students that may potentially run off. Students must be able to exhibit independence and ability to follow a sequence of instructions. Please note, our social groups and summer camps are not suitable for students who need a lot of structure. *
Contact info: How can we reach you? Please provide your name and email *
Your answer
If you have any additional notes, feel free to add them below. Thank you for your time, we will reply back soon to arrange a time to meet :-)
Your answer
Would you like to subscribe to our monthly newsletter? We share advice, tips and give updates on all the programs. We will use the email address given above. *
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