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
) 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 :)
First and Last Name of Guardian(s):
Participants/Child's First and Last Name:
Participant's birthday (day/month/year):
Please identify your child's exceptionality here in proper medical terms:
Other Relevant Medical Information (i.e Allergies, Epi Pen) :
When my child tries new things/ is physically challenged, he/she:
When my child meets new friends, he/she feels:
When my child hears music, he\she responds by...
Make little movements
Engage with others
Feeling scared or anxious
Cautious and curious
My child prefers music that is:
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:
My child's range of motion is:
No physical issues to be concerned about
Sometimes my childs coach will need to remind me to:
Something that is unique about my child is:
One new thing my child wants to learn this session:
Please feel free to add anything else about your child that you feel is necessary for our instructors to know:
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