Student Enquiry Form

Please fill out the form below so we know more about your child!

Your Email

Your Child's Name

Your Child's Behaviour

Tell us about your child’s early behaviours once you noticed a behavioural pattern and/or health signs.

1. What behavioural/medical concerns does your child have? What age did it happen?

Behavioural/Medical Concern	Age
delayed speech
attention & focus
lack of social interaction
fixation of a specific subject or area
low tolerance of physical sensation (noise)
poor muscle co-ordination
lack of physical flexibility
learns slowly

Other concerns:

2. What challenging life experiences had your child faced or is still facing? What age did it happen?

Life Experiences	Age
bullying
parental expectations/pressure
verbal abuse
physical abuse
sexual abuse
death
divorce
serious illness
social exclusion
sibling or peer comparison

Other life experiences:

Your Child's PINS

Please help us to understand your child’s Preferences, Interests, Needs and Strengths (PINS). This helps our coaches and volunteers to align to the needs of your child. Tick the box that applies from your fact-based understanding in what your child has done and what your child has said.

	Academia	Learning	Employment	Independent Living
Preferences	Prefers: ReadingWritingNumbersContinuing StudiesGetting a jobOthers Please specify:	Learns by listeningLearns by seeingLearns by doingKnowledge-drivenSkills-drivenBetter with computersBetter with hammers, drills, saws, pillers etcOthers Please specify:	Prefers: Working aloneWorking with othersWorking in an office or in a buildingWorking outside of a buildingBeing in chargeBeing told what to do in a jobJob with no expectationsJob with specific goals & deadlinesWorking in a quiet, slow-paced jobWorking in a noisy, fast-paced jobWorking with childrenWorking with adults	Prefers: Getting up and doingSitting and listeningLiving aloneLiving with others (parents, family, siblings)To have a familyNot to have a familyStaying neat and cleanMess and getting dirty
Interests	ReadingNumbersWritingExperimentsHistoryWorld we live in	Computer graphics, design, coding, etcDrama, acting, etcBoard gamesComputer gamesArt (drawing, pottery, painting, etc)	Job attachment (unpaid work)ApprenticeshipOn-job trainingWork indoorsWork outdoors	HikingGamingOrganised sportCommunity serviceLive aloneHave a familyInteract with opposite sex
Needs	ReadingNumbersWritingScienceHistoryGeography	Information GatheringComprehensionSolving problemsMaking decisionsListeningGaining focus	Trial unpaid workTrial paid workTemporary jobPermanent jobCo-operation (work with others)Taking NotesComprehensionSolving problemsJob that is busySolving problemsPortfolio/CV/Resume	Help with directions in a public areaHelp with travel on public transportAsk for assistancePlan/organise each dayKnow who to trustStart a conversationShow appreciationManage stressDeal with opposite sexDeal with affections
Strengths	Good at: ReadingMathWritingScienceHistoryGeographyOthers Please specify:	Staying healthy & fitEating good foodsAttending to a childGood in art and drawingPlaying a musical instrumentKeeping physically activePicking up technologyFollowing directionsFinishing tasks correctlyFinishing tasks on time	Works well: Using handsWith wordsWith numbersUsing computersIndependentlyCo-operativelyWith peersWith childrenWith adults	Staying organisedSolving problemsFocus on detailsExercise responsibilityShows self-advocacy (asks for help, expresses needs)Confident in public speakingInteracting with others

Your Child's Development Needs

Tell us about your child’s early behaviours once you noticed a behavioural pattern and/or health signs. (repetitive behaviours of 5 or more times)

1. Which specific development needs in your child do you need help with?

speak more openly with othersstay focused and engagedinteract with others in age groupbe flexible and not rigidlisten to instructions and repeat themimprove physical-visual co-ordinationthink flexiblylearns how to react with best emotions

2. In six months, which development needs would you like your child to make progress in (be realistic)?

better emotional strengthlistens and pays attentiongrasps information accuratelyexercises initiative in tasksreadily volunteers to helpimproved mental and physical strengthis timely and organisedsets personal goals and rewards

Extra:

3. What is your child’s (and your) long term aspirations?
Aspirations (child):
complete form schoolidentify career choicesstrengthen specific skills & habitswrite a 12-24 month plansecure paid employmentimprove emotional strength

Aspirations (both):
talk more to each othereat more healthily togetheragree ‘family time’ in a weeksupport each other at Care2Run eventscultivate & strengthen sibling supportdiscuss about opposite sex

Extra:

4. How does your child spend his/her time at home?


5. Average hours per week the child spends:

Screen time (television, computer/handphone, CDs) (hrs):

Do homework (other work) (hrs):

6. What is your child's preferred way to communicate or express himself/herself?


7. From your observations, in what situations/environments does your child learn best?


8. What types of enrichment or extra-curricular activities is your child involved in at school and out of school? (Please include any therapy and developmental programmes your child is attending)

Your Child's Employment Choices

What are some employment choices you feel your child would like to pursue?

Your Child's Confidence & Self-Esteem

Tell us about your child’s self-esteem and confidence. Do you feel your child needs extra attention or focus in developing social skills and overall confidence? If Yes, what are some suggestions in increasing your child’s self-esteem?

Other Programmes

Tell us about all the other physical and psychological intervention programmes that your child has attended in the last 6 months:

Your Additional Feedback

What additional feedback of your child is useful for our coaches to be aware about?