Comprehensive Program
Registration Form

Page 2

Email address
* Required Field Please enter email address again
Give a brief history of your child's development.
List any prior training or programs (to help your child) that you and /or your spouse have attended. Include the method and/or name of the organization that provided the training and your dates of attendance.
Do you
currently have a home-based program for your child (or have you tried one in the past)?
Yes     No    
If yes, please describe the program: methods used, approximate number of hours per week, number of people involved, how long you have been doing it, etc. If you no longer do the program, when and why did you stop?  
Give a brief description of your child's current development in terms of...
Fine Motor:
Gross Motor:
Social Skills:
Please check if you are an animal. Yes No
Self Help Skills: