Application for MC Play Matters!
In home program development and family training with a focus on teaching and expanding play skills. This is a consultation service with the goal of training family members to carry over the teaching strategies into the natural environment and day to day interactions with their children.

This service is most appropriate for children who:

-Demonstrate limited motivation to interact with others

-Engage in restricted, repetitive, stereotyped play

-Experience conflict in play with peers/ siblings (rigidity, difficulty with turn taking & tolerating losing)

Families will be required to sign a contract outlining family responsibilities and committing to consistent meetings for a minimum of 6 months to allow for the following:

-Assessment

-Goal Development

-Family Training

-Ongoing Progress Monitoring

The fee for the service is $1500 for 6 months (split into 3 payments) which will include multi day assessment, 1x per week home visits initially then 2x per month visits during maintenance phase, 1x per month phone/video conferencing during maintenance phase, review of data and video & development of resources/additional supports to promote skill acquisition, generalization and maintenance across settings.

*This initial application is merely an expression of interest and a means of providing our team with some preliminary information to determine whether this service delivery may be a best fit. There is no cost to complete the application. Please allow 24-48hrs for the form to be reviewed. At that time, our team will follow up with you regarding next steps.

Thank you for your interest!

Parent/Guardian Name *
Your answer
Parent / Guardian Email *
Your answer
Parent / Guardian Phone Number *
Your answer
Child's Name *
Your answer
Child's Age *
Your answer
Diagnosis if any *
Your answer
In your own words, describe how your child uses his/her free time in a setting where toys and other activities are available but no adult or skilled sibling/peer is providing explicit instruction regarding how to use that time *
Your answer
Describe primary play engagement when peers/siblings are present *
Required
Are there siblings in the home? If yes, what are their ages? *
Your answer
Do you have an area in our home which we can designate for play *
Is a parent/ guardian available during the day to participate in training *
Can you commit to consistently implementing strategies and devoting time to supporting play daily (even if it's 15 minutes)? *
Can you commit to taking simple data/notes regarding play sessions and progress to help the team's decision making process? *
What are you most hoping to gain from this service? *
Your answer
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