Week 4-July 8th-12th Afternoon Technique and Clay Date Ages 8 and Up

Child Name

Age

Gender Pronouns:

Communication Plan

Best way to reach Parent/Guardian:
Phone Email

In Case of Emergency:

Contact Person 1

Contact Phone Number

Contact Person 2

Contact 2 Phone Number

Important Medical Conditions

Medical Condition:

Allergies:

Medications:

Additional Information

My child’s favorite activities include:

My child’s strengths are:

Things that motivate my child include:

Tools that are helpful for my child include:

Additional Highlight to Note:

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