MoveAbility Kids - Get to Know Me Form
Please fill out this application as it will help our coaches develop a more unique program around your childs abilities! Write in the text area below the question and click SUBMIT ( to
MoveAbilityGuelph@gmail.com
) when you are finished! You can also opt to print this form and fill it out by hand and bring it to your first class if you prefer :)
* Required
Email address
*
Your email
First and Last Name of Guardian(s):
Your answer
Home Address:
Your answer
Phone Number:
Your answer
Participants/Child's First and Last Name:
Your answer
Participant's birthday (day/month/year):
*
Your answer
T-shirt size
xsmall youth
small youth
medium youth
Large youth
XL Youth
Small Adult
Medium Adult
Large Adult
Please identify your child's exceptionality here in proper medical terms:
Your answer
Other Relevant Medical Information (i.e Allergies, Epi Pen) :
Your answer
When my child tries new things/ is physically challenged, he/she:
Your answer
When my child meets new friends, he/she feels:
Your answer
When my child hears music, he\she responds by...
Dancing
Singing
Make little movements
Engage with others
Feeling scared or anxious
Cautious and curious
My child prefers music that is:
all types
other
Please select any option that describes your child:
Busy mind and busy body - always on the move!
Taking turns can be challenging
He or she is most successful when instructions are slowed down to allow for longer processing time
Gets frustrated easily when challenged with new things
He or she has difficulty working with partners or in groups
Often needs reminders to not wonder off!
Shy and finds it hard to communicate when something is wrong
Often has negative physical responses towards coaches and teachers
Often has negative emotional responses towards coaches and teachers
Sometimes my child has trouble with:
Language\Speaking
Comprehension\Understanding
My child's range of motion is:
Extremely limited
Partial mobility
No physical issues to be concerned about
Sometimes my childs coach will need to remind me to:
Your answer
Something that is unique about my child is:
Your answer
One new thing my child wants to learn this session:
Your answer
Please feel free to add anything else about your child that you feel is necessary for our instructors to know:
Your answer
Submit
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