Please complete this enrollment form for families of children with special needs.  If you have any specific questions/concerns, please contact Michael Poorman (michael@parkview.cc)
start
 
Child's First Name *

 
Child's Last Name *

 
Birthdate

 
What grade is {{answer_44795270}} in school? *

 
Parent/guardian info

 
Names *

 
Cell Phone number:

 
Which service do you usually attend?


 
What are {{answer_44795270}}'s primary health concerns that we need to be aware of? *

 
If there are any specific needs we should be aware of please list.

(vision, hearing, motor, communication, eating, etc)
 
Does your child have an IEP or Behavioral plan?

     
 
Please upload the plan

 
Please list any allergies we should be aware of.

 
Does {{answer_44795270}} need any assistance with toileting? *

     
 
Please indicate any special toileting needs or schedules.

 
Please select all that apply to your child's behavior *


 
My child responds to separation from parents/guardian by: *

 
{{answer_44795270}} is best comforted by: *

 
How does your child let someone know what they want or need? *

 
What type of play activities  does {{answer_44795270}} enjoy and/or participate in? *

 
Your child becomes upset when or does not enjoy what? *

 
Are there any other concerns not already addressed? *

Thank you. We will be in contact with you.