top of page
Accommodations Intake Form
Use tab to navigate through the menu items.
Child's Date of Birth
My child has the following learning difference, diagnosis, or medical condition:
My child has the following area(s) of interest:
My child needs assistance with (ex: using restroom, reading, writing):
My child is uncomfortable with (ex: loud noises, bright lights, physical touch):
My child may become frustrated, or a behavioral problem may occur when:
When/if my child experiences frustration, he/she calms when:
My child does or does not enjoy music:
Is there anything else you would like us to know about your child?
Our family has grown through one of the following: Adoption, Foster Care, Safe Families.
I have read this intake form and verify that the information is true.
I want to subscribe to the newsletter.
Thanks for submitting!
bottom of page