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Playgroup Questionnaire - About Your Child
1.
Child’s Name
2.
Child's Age
3.
Communication Style: How does your child communicate? (Check all that apply)
Verbal
Non-verbal
Uses AAC
Limited speech
Other (please specify)
4.
Sensory Preferences: Does your child have any sensory sensitivities?
Sounds
Bright lights
Textures
Crowds
Other (please specify)
5.
What sensory tools (if any) do they use? (e.g., headphones, weighted blanket)
6.
Strengths and Interests: What activities does your child enjoy?
7.
Triggers and Calming Strategies:
Are there common triggers for your child (e.g., loud noises, transitions)?
What helps your child calm down when upset or overwhelmed?
8.
Social Preferences: How does your child prefer to interact with others? (Check all that apply)
Enjoys group play
Prefers one-on-one play
Prefers parallel play
Needs support with social interaction
Other (please specify)
9.
Medical/Allergy Information: Does your child have any medical conditions or allergies we should be aware of?
Yes
No
Please specify:
10.
Additional Support: Are there specific accommodations or supports that help your child feel comfortable and successful?
*
11.
In your opinion, does your child require 1:1 care while attending play group?
(Required.)
Yes
No
Please provide additional detail so that we can ensure proper staffing and support for every child.
12.
Do you have any specific goals for your child?
13.
Contact Information
Name:
Phone Number:
Email
Relationship to Child:
