Team Bel Air Student Application Form
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
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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 *
MM
/
DD
/
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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