Special Need Family Input

Full Name

First Name Last Name
Level in Lamdeni*

Level Day in Lamdeni
Birth Date:*

Month Day Year
Age:*
Diagnosis:*
Medication (if any):*
Parent Details:*

First and Last Name Contact Number
Emergency Contact:*

First and Last Name Contact Number
My child's strengths: *
My child's interests and activities he/she enjoys:*
How does your child communicate and does your child require support to communicate:*
How does your child engages in play with others at different times of the day/different environments:*
Recommendations for Lamdeni:*
What is challenging for your child?*
How does your child settle in to a new environment?*
Recommendations for Lamdeni staff in assisting your child in an event of your child becoming distressed. *
Special Food restrictions / requirements (if any)*
What areas does your child require support:*
YOUR (family) expectations and needs:*
The relationship between the family and Lamdeni – how can we ensure successful experience for your child at Lamdeni*
Does your child need assistance with toileting?*
Other specific suggestions for Lamdeni environment:*
Documents required:

* Doctor diagnosis and any medical evidence/letter

* Any relevant information/handouts explaining your child’s diagnosis/difficulties
Should be Empty:

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