School Readiness Program

Child's First and Last name*

Guardian's Fisrt and Last name*

Child's Birthday*

Year

Month

Day

Email*

Phone*

Please choose a week or both

August 11-15

August 18-22

How does your child communicate?*

Speaking

Non-Speaking

Visuals

AAC

Gestures

What areas would you like us to focus on the most?

Waiting

Independence

Patience

Social Skills

Communication

Circle Time

Do you need Individual Support? (additional $25/h)

Yes

No

Please list any triggers

Please describe de-escalation procedure

How would you like to pay?*

AFU

E-transfer/credit

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