Team Bel Air Student Application Form

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Hi Parent,

Thank you for your interest in our martial arts program.

This form has 5 main sections:
1. General Information
2. Challenging Behaviors
3. Support Plan
4. Goals
5. 1-on-1 Assessment Class

Please be as detailed as possible when completing this form. It will help us to better know your child with your recommendations and desired goals.

Your information will not be shared and will remain confidential.

For any questions or comments, contact me at alex@teambelair.com

Email *

Your Full Name *

Phone *

Zip Code *

How did you hear about us? If applicable, indicate who referred you to us. *

If you heard about us from a Facebook group, please specify which one. Thank you.

Child's name *

DOB *

YYYY

School

Therapist(s)

Please indicate the name of each clinic with the type of therapy your child is getting

Diagnosis

Formal or suspected diagnosis

Favorite Activities and Interests *

Most Disliked Activities

Past and current sport activities *

List past and current sport activities, and describe his/her overall experience.

Strengths *

Ex: personality traits, social, language, literacy, math and logic, study, sport, art, ...

Profile - Additional Comments

Anything else that you want to us to know (Ex: health, sleep, diet, routine schedule/workload, character traits, relationship with educators, important life events)

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