SEND/Inclusion - Children/Young People Pre-Activity Form
This form is used to help us understand your child better. Please try to be as detailed as possible so our staff are well prepared to best accommodate your child.
Child's name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Does is your child currently in education?
*
Yes, mainstream
Yes, specialist provision
Home education
No, not currently in any kind of education
If yes to above, what school?
Does your child require 1:1 or 2:1 support?
*
1-1
2-1
No
Does your child have a medical diagnosis that we need to be made aware of?
*
Does your child have a diagnosis or disability that we need to be made aware of?
Yes
No
If yes to above please inform us of the diagnosis/disability:
Does your child have seizures?
*
Yes
No
Does your child have a visual or hearing impairment?
Yes visual
Yes hearing
Yes both
No
Does your child have a visual or hearing impairment? Please describe
*
Is your child likely to behave unpredictably (eg shuts down, hides, absconds, physical)? If yes, please describe
*
Just put N/A if this doesn't apply to your child
Does your child understand danger? Please describe
*
Just put 'yes' if this doesn't apply to your child
Child’s preferred method of communication?
*
i.e verbal, PECS, BSL etc
Is your child comfortable in busy environments?
*
Yes
Sometimes struggles
No, needs a quiet environment
Please detail any social support your child needs?
*
Does your child need assistance with a physical disability? If yes, please describe
*
Child likes and dislikes?
*
Child dislikes?
*
Worst case scenario. Please describe the most extreme behaviour your child will display if they are very upset/stressed.
*
Please add any additional information on how we can best accommodate your child and make sure they have the best time (eg please detail any social support your child might need)?
*
Would you like us to keep your information to inform you of future SEND events?
*
Yes
No
Please provide your email address
*
example@example.com
Please provide your phone number
*
Please enter a valid phone number.
Format: (00000000000).
Submit
Should be Empty: