Xtreme Kids Additional Support Form - St Albert Alliance Church

Household members

Please add your child's information below.

Please tell us about any health and medical needs that would allow us to best support your child and keep him/her safe:

Any formal diagnosis, medical concerns or learning differences?

Food allergies/sensitivities?

Sensory issues:

Please describe their learning environment at school.

Will a support worker be staying with your child?

What are your child's strengths and interests? What does your child enjoy?

Are there any behaviours that could cause harm to themselves or others? Please explain.

If my child needs the washroom, he/she will communicate by:

If my child needs some prompting to maintain attention or engage in safe play with others, the best strategies for my child are:

If my child gets frustrated or upset, he/she will:

The best way to calm my child is...

Helpful phrases that encourage my child are...

My child may require help with:

Check all that apply.

Separating from parents

Making friends

Communicating

Following directions

Using the washroom

Small motor activities

Eating

Writing

Reading

Remaining on task

Staying in the classroom

Managing loud noises

Managing crowds

Transitions (ie. Changing activities or moving to a different room)

Other

What is one goal you have for your child in Xtreme Kids?

Is there anything else you would like to share with us about your child?