Gender *
Select… Male Female
Grade *
Select… Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
School
Select… Montford Middle School Deerlake Middle School Raa Middle School North Florida Christian School Community Leadership Academy Maclay School Holy Comforter Episcopal School Lawton Chiles High School Lincoln High School Leon High School North Florida Christian School Community Leadership Academy Maclay School Community Christian School Homeschool/Virtual Christ Classical Academy
Medical note
Diagnosis / Allergies
Phone number *
Parent/Guardian Phone Number
Phone type Mobile Home Work Other
Household members
Will other members of your household be joining us on your visit?
+ Add adult + Add child Motor Skills
Does your child use any type of assistive motor device (i.e. wheelchair, stroller, walker, AFOs, etc.)?
Communication Skills
How does your child communicate?
Toileting Needs
What is the best way to assist your child if they need to use the restroom?
Are there any behaviors your child may display that we should be aware of?
Are there certain situations that tend to illicit these behaviors?
Is there a behavior management plan in place at home or school that would be helpful for us follow?
i.e. Reward system, certain words, actions taken if behaviors occur, etc.?
Which service/event do you plan to attend? *
Is this your first time visiting Bradfordville FBC? *
Submit
