MEETING THE NEEDS
OF EVERY CHILD
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Donna Palmer
Alexandra Lily
Cheryl Charles
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Cameron
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Emergency Anaphylactic Allergy
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✕
Home
About Us
Donna Palmer
Alexandra Lily
Cheryl Charles
Our Programs
Pre School Program
Daily Activities
Tutoring
Respite Care
Parents Support
In Home Visits
Parenting Beyond Behaviors
Parent Child Play Group
Gallery
Events
Quarterly Moms Night
Parents Inspiring Parents
Annual Summer BBQ
Annual Christmas Party
Blog
Case Studies
Riley
Cameron
Testimonials
Forms
Rate Sheet
Admission
Terms of Enrolment
Training Consent
Dietary Arrangements
Emergency Anaphylactic Allergy
Contact
Home
About Us
Donna Palmer
Alexandra Lily
Cheryl Charles
Our Programs
Pre School Program
Daily Activities
Tutoring
Respite Care
Parents Support
In Home Visits
Parenting Beyond Behaviors
Parent Child Play Group
Gallery
Events
Quarterly Moms Night
Parents Inspiring Parents
Annual Summer BBQ
Annual Christmas Party
Blog
Case Studies
Riley
Cameron
Testimonials
Forms
Rate Sheet
Admission
Terms of Enrolment
Training Consent
Dietary Arrangements
Emergency Anaphylactic Allergy
Contact
✕
Home
About Us
Donna Palmer
Alexandra Lily
Cheryl Charles
Our Programs
Pre School Program
Daily Activities
Tutoring
Respite Care
Parents Support
In Home Visits
Parenting Beyond Behaviors
Parent Child Play Group
Gallery
Events
Quarterly Moms Night
Parents Inspiring Parents
Annual Summer BBQ
Annual Christmas Party
Blog
Case Studies
Riley
Cameron
Testimonials
Forms
Rate Sheet
Admission
Terms of Enrolment
Training Consent
Dietary Arrangements
Emergency Anaphylactic Allergy
Contact
ADMISSION FORM
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Emergency Contacts (name; relationship; phone numbers & address)
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Release to (names and relationship)
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Specialized adaptations
Hand over hand assistance for feeding and classroom activities
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Stimulating inside the child’s mouth before/after meal times with a specialized spoon or probe provided by the parent
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Elevate bed at sleep time (when deemed necessary by staff)
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Use of reinforcements (dependent on what the child would work for)
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Use of specialized equipment (chairs; benches; stools; walkers etc)
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Use of switch activated equipment
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Durham Behavior Management
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Grandview Kids
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Is there anything else that we should know about your child, your goals, expectations or the concerns that brought you to our services?
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Medical History
Child’s Name
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History of Communicable Diseases (list the ones your child has had in the past) eg. Rubella; Measles; chicken pox etc
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Does your child have allergies?
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(if yes please complete allergy alert form)
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Does your child have a diagnosis?
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Do you have any concerns about your child’s development in the following area? Please provide details
Hearing
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Vision
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Eating
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Mobility
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Self Help
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My child likes to eat:
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