FILL OUT THE INFORMATION BELOW TO GET STARTED!

Name of Parent/Guardian:

Do you have another person involved?

Basic infomation on Child:

yrs.

Gender:

What School does your child attend:

Please tell us a little about your child, please check all things that apply.

Communication:
Social Skills:
Behavior:
Does your child have aggression:
What are your child’s interests:
Playing Video Games
Movies
Building/Making things
Playground Games
Art
Music
Sports
Hiking
Jungle Gym
Arcades
Other Interests

We expect initial meetings to occur under the direction of trained facilitators inside SportsSocial’s building. Later meetings may be facilitated between the parents at other locations. To help us better match the children, please provide information on how and where these meetings might best occur.

mi.

What type of venue would you like to meet at:

Does your child struggle with sensory processing:

Touch
Light
Sound
Smell
Food

What are your child’s physical capabilities:

Riding a Bike
Running
Climbing
Swimming
Jumping on a trampoline/bounce house
Bowling
Playing Video Games
Playing Board Games
Building Legos
Other capabilities

Does your child have a handicap? If so, please describe:

Boy-Girl Match Acceptable?

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