Intake | Watermelon Sessions

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Welcome New Families!

All our Services are covered with the AFU funding.

Please fill in the intake form and we will get all the fun started.

First name*

Last name*

Email*

Phone*

Address*

Child's First Name*

Child's Last Name*

Birthday*

Month

Day

Year

What Services are you looking for? *

Group Classes

Respite

Camps

Speech Therapy

Occupational Therapy

Physiotherapy

Counselling

Area of focus*

Communication

Emotions

Life Skills

Education

Separation Issues

How does your child communicate? *

Speaking

Non-speaking

AAC

Visuals

Semi-speaking

Sign language

Please list any triggers*

Please provide de-escalation procedure*

Please list any allergies*

Please list your child's interests/powers*

Please give us any other notes that will be helpful to know

Intake Form

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