We are grateful that you have chosen for your child to spend time with us at PAALS, as we know the challenge of choosing and scheduling activities. With your guidance and support, we can enhance his/her physical, emotional and social well-being. By learning more about his/her personality and needs, not only can we customize our activities and conversations to help him/her grow stronger inside and out, we can interact and respond to him/her more effectively. We want your child to have the strategies to effectively navigate their relationships and everyday lives, and to feel confident in themselves and their abilities. Please share anything you are comfortable with us knowing (note: you do not have to fill in anything you don’t want). All information provided is strictly confidential. Your name* First Last Your Child’s InfoName* First Last Birthday* Date Format: MM slash DD slash YYYY Grade*PreschoolKindergarten1st2nd3rd4th5th6thotherOther (please specify)*School Name & District*What is your child’s place in the family: The oldest The youngest The middle Only child Does your child participate in after school activities?YesNoIf so, which one(s)?Briefly describe your child’s abilities/feelings about sports, physical activity, exercise.What do you hope your child gains from PAALS?Check all that apply Confidence & Self-Esteem Being open to trying new things Willingness to be physically active Enhancing social skills / interacting with others Better attitude (respect, sportsmanship, communication, etc) Other Other (please specify)Please Describe in more detailDoes your child have separation anxiety?YesNoHow would you like us to handle it when your child does not want to participate?Ie: for some girls, they choose not to participate because they want the attention, so us going over to them actually does more harm than good. For other girls, they just need some time to adjust to new situations and then we would go over after a little while. So any insight you can provide here would be helpful, including how persistent you think we should be / how hard we should try and/or how often we should go over to them. Is your child comfortable in new settings / environments / new activities?YesNoHow does she behave? How can we help?*Does your child make friends easily?AlwaysMost of the timeSometimesNot very easilyNeverDoes your child have any specific and/or recurring issues with friendships?YesNoPlease share moreFor the most part, does your child communicate well?Most of the timeHardly everWith family onlyWith children onlyWith adults onlyPlease share moreFor the most part, is your child respectful of others?YesNoIn group situations / team activities, would your child be comfortable leading?YesNoMaybe a little too comfortable, my child is always a leader, which can sometimes make trouble.Would your child beVolunteering to leadOk leading if askedNot comfortable taking on that role at allIs your child easily distracted?YesNoDoes your child make eye contact?YesNoDoes your child have any fears/anxieties we should be aware of?YesNoPlease share moreIs your child aggressive?YesNoPlease share moreIf so, how do you suggest handling?Has your child been diagnosed withADD or ADHDDepressionAnxietyLearning DisorderOther mental, emotional or social disorderPlease share moreIf so, please note compensation indicatorsFeel free to share any additional information about your child that you would like us to know / work on at our program.Privacy* By using this form you agree with the storage and handling of your data by this website. * This iframe contains the logic required to handle Ajax powered Gravity Forms.