A Child Can Do All Things


Returning Student Application Form

Please note:

  • Submission of forms does not equate to acceptance in program.
  • A Child Can Do All Things will notify you as to acceptance into the program.
  • * Indicates a required field
APPLYING FOR SESSION:
2008 July Program 2008 September Program 2008 October Program
2008 November Program 2009 January Program 2009 February Program
 
Last Conductive Education school session attended:*
 
CHILD'S PERSONAL INFORMATION
Name:* Gender:* Date of Birth:*
Child Resides with:*
Address:* City:* State:* Zip:*
Home Phone:* Work Phone: Cell Phone:
Contact E-mail:*
 
Current Medications/Botox Treatment: (name/doses/times)
 
Any changes in medical condition since last attendance at program:
 
Current therapies/schooling (type/frequency/where):
 
Please list the equipment and adaptive devices that your child uses (i.e. AFOs, splints, etc.):
 
Please provide an update regarding current skills in:
Mobility:
Self-care:
Speech/Language:
 
What current goals do you have for your child?
 
Please provide any other information you feel should be known by the staff:
 

Karissa Patterson, Program Director
A Child Can Do All Things
12870 Hillcrest Road H-101
Dallas, Texas 75230
 
 


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