Parent / Guardian's name
*
First Name
Last Name
Parent / Guardian's Email
*
Child's name
*
What school does your child attend?
*
Does your child have any specific emotional or behavioural challenges (e.g., difficulty managing anger, anxiety in group settings)?
*
Has your child been diagnosed with any medical, behavioural, or developmental conditions (e.g., ADHD, autism, anxiety)?
*
Does your child receive any additional support at school (e.g., 1-1 support, learning assistant)? Please provide details
*
Are there any particular strategies or techniques that work well in helping your child feel calm and supported?
*
Does your child have any allergies or medical conditions that we need to be aware of (e.g., epilepsy, allergies, dietary requirements, asthma)?
*
Is there anything else we should know about your child to ensure their wellbeing and positive experience at THHP?
*
Does your child require any assistance with personal care and/or using the bathroom? Please provide details.
*
Where did you hear about us?
*
Please let us know if it was a recommendation so that we can thank the parent!
How old will your child be at the time of the class?
*
5
6
7
8
9
10
11
Emergency contact
*
First Name
Last Name
Emergency contact number
*
(###)
###
####
Emergency contact 2
*
First Name
Last Name
Emergency contact 2 number
*
(###)
###
####
Would you like to be added to our mailing list to hear about classes, workshops and webinars?
*
Yes
No
