Tell us about your child

* 1. Your child's first and last name?

* 2. Which age group are you interested in for this summer?

* 3. For how many weeks do you want to attend? If less than 6 weeks, please indicate which dates will be missed?

* 4. Demographics

* 5. What is his/her diagnosis?

* 6. Does your child want to attend BADP? If so, please explain why? If not, please also explain why? This will better prepare us for the intake.

* 7. Please describe in detail his/her social difficulties in structured settings, such as the classroom, organized sports, etc...?

* 8. Please describe in detail his/her social difficulties in unstructured settings, such as gym, recess, play-dates, birthday parties, after-school activities, etc...

* 9. What are the typical triggers that make your child upset?

* 10. What is an effective way to intervene when your child becomes upset?

* 11. Do you use time-outs? If so, how easily does your child take a time-out? Is there every any resistance? If so, why kind of resistance? Please be specific.

If you don't use time-outs, why not? What do you do instead when he/she is non-compliant, breaking rules or acting unsafe? Please be specific.

* 12. What group activities does your child do after school or on the weekends? sports, gymnastics, robotics, etc. Are there any specific social issues you notice?

* 13. What services is your child currently receiving outside of school?

* 14. Describe his/her academic difficulties that you want him/her to improve over the summer?

* 15. Briefly describe his/her strengths?

* 16. What incentives, if any, motivate your child (e.g., charts, points, toys, money, food, TV, video games, etc...)

* 17. What did your child do last summer? Did he/she attend camp? Please describe any notable issues that would help us for this summer?

* 18. Any current or recent (in past 6 months) history of aggression to kids (peers, siblings, etc..) or adults (parents, teachers, etc...), running away or destruction of property?

* 19. Any current or history of sexual abuse or trauma with your child or in the family?

* 20. Does your child have any self-care issues (e.g., toileting, changing clothes, etc...)

* 21. Does your child have any medical or physical problems? Allergies? Food issues? Major dietary restrictions?

* 22. Does he/she take medication? If yes, please describe with names of medications and reason for taking the medication.