After School Program @ Fun Feats

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This introduction form helps us get to know you better. Our colleague will contact you soon after receiving your form

Email *

Name of Child *

Child's Date of Birth *

Which school does your child goes to and how often does your child attend school (example; Monday to Wednesday 9am to 12pm)? *

Share with us if your child has any diagnosis/conditions or learning challenges in school. *

Please indicate which of these ADL (Activities of Daily Living) your child is able to do independently/minimal supervision*

Independent in Toileting

Independent in Dressing/Changing (in the event they soil themselves)

Independent in Eating

Able to keep their used utensils and plate after eating Independently/with minimal guidance

Able to follow daily schedules independently/with minimal guidance and listen to instructions

Required

Please share any ongoing therapy (e.g. speech therapy, occupational therapy, educational therapy, etc) that your child is having currently.

If your child does not have any ongoing therapy, please indicate None

Please share your child's medical history and allergies.

If your child do not have any medical history, please indicate None

Any dietary requirement? We conduct nutrition and meal preparation sessions on some days. Do indicate no if 'None' *

Who is the primary caregiver of your child?
*

Parent

Sibling

Spouse

No primary caregiver

Other:

Required

Name of Caregiver *

Caregiver's Contact number *

Staying in which area of Singapore *

Is there anything else that you want to let us know about your child?

Any special things to take note of?

(e.g sensitive to high pitched sounds, self-injury tendencies etc)

What are your child's hobbies and interests? likes and dislikes?
*

I hereby declare that the details furnished above are true and correct to the best of my knowledge. I agree to give consent for Fun Feats to use the information for the administration and provision of services.

I also understand that photographs/videos may be taken during the course of this programme and may be used for publication in Fun Feats's website, newsletters and/or other marketing materials. Please write in to info@funfeatstherapy.com at least 1 month in advance if you wish to withdraw your consent.

Yes, I agree

No, I disagree

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