LDS Special Needs Program

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Let's Dance Studio is now offering Special Needs dance classes. Students will be taught by a certified instructor and we will have a low student to staff ratio. If you are interested in our Special Needs program please complete the student profile below and mail or bring into Lets Dance Studio.
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Let's Dance Studio Child Profile 2009-2010

*Upon completion, we will review this profile and determine your child's compatibility with our program. Click here for the Microsoft Word version of this profile. If needed, please call us at 856-881-5930 to have a student profile mailed or feel free to stop in.

Question

Answers

•  Name and Age

•  Address

•  City

•  State

•  Zip Code

•  Phone

•  Email

•  Birth date

•  Emergency Name and Number

•  Tee Shirt Size

Diagnosis

Question

Answers

•  Child's Diagnosis

•  What is the level of involvement of your child's disability? (Mild, Moderate, Severe)

•  If Other, Please describe

•  Does your child have any fine or gross motor skills limitations?

•  Can you child function independently? (Bathroom, shoes, etc.)

Communication

Question

Answers

•  How does your child communicate? (Verbally, communication device, picture board, sign language)

•  What type of schedules works best for your child? (Written schedule, photo schedule, etc.)

•  Can your child ask for help?

Yes/No

•  Can your child communicate an illness or pain?

Yes / No

•  Can your child listen and follow directions appropriately?

Yes/No

Behaviors

  Question

Answers

1. Are there physical, medical, sensory or behavioral concerns that we should be aware of? (Non-compliance, hitting self or others, tantrums, self stimulatory behaviors) Please give us information on the best way to avoid and deal with those issues.

2. In your child currently on a behavior management plan?

Yes/No

3. What type of reinforcements and/or rewards work best to keep your child motivated?

4. Does your child have any fears or anxieties we should be aware of?

•  Please describe your child's attention span.

Miscellaneous

  Question

Answers

•  What are your child's strengths?

•  What would you like your child to get out of his/her experience?

•  Is there anything else we should know about your child to make his/her experience a memorable one?

•  Why would you like your child to be a part of this program?

 

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