Client details & Support Form

- Does the participant take regular medication? (If yes, please specify name and dosage)

- Any diagnosed allergies (including food or environmental)?

- Relevant medical conditions (e.g. epilepsy, asthma, heart condition)

- Is there a Health or Emergency Plan in place?

Yes No

🧠 Behaviour Profile & Preferences

- Known Triggers (what might cause distress or dysregulation)?

- Strategies that help regulate?

Movement / space to pace or jump Pressure or deep touch Preferred toy or object Visual support (first/then, countdown, etc.) Quiet space or break Supportive adult staying nearby Breathing exercises / calming prompts

- Level of Support Needed When Dysregulated

Can self-regulate with minimal prompts Needs adult nearby and occasional guidance Needs active adult support throughout episodes Requires 1:1 continuous supervision when distressed

- Additional Notes on Behaviour

🗣️ Communication & Interaction Profile

- What best describes the participant’s expressive communication? (You may select more than one)

Verbal – full sentences Verbal – limited words or scripts Uses signs (e.g. Makaton) Uses AAC (e.g. tablet, GoTalk, speech device) Uses PECS or visuals to express needs Gestural or non-verbal cues (e.g. pointing, taking adult to item) Mainly communicates through behaviour

- How does the participant best understand instructions?

Verbal instructions only Verbal + gestures Visual support needed (e.g. symbols, schedules, first-then boards) Needs 1:1 adult support to process instructions

- Preferred Communication Strategies That Work Well

🧩 Independence & Daily Participation

- Mobility & Physical Independence

Walks independently Needs support on uneven surfaces or stairs Uses mobility aids (e.g. wheelchair, walker) Needs adult assistance for transitions or moving between spaces

- Personal Care

Fully independent (e.g. toileting, dressing) Needs reminders or verbal prompts Needs physical assistance or supervision Uses continence aids (e.g. pads, support garments)

- Task Engagement

Can follow a simple routine independently Needs visual or verbal prompts to stay on task Needs 1:1 support to complete most activities Easily distracted or requires frequent redirections

- Transitions & Flexibility

Adapts easily to change in activities or environment Needs preparation or countdowns for transitions Struggles with unexpected changes or waiting time

- Risk Awareness & Safety

Understands basic safety rules (e.g. not running off, pool safety) May act impulsively – needs supervision No awareness of danger – constant 1:1 required

- Anything else we should know about?

🕒 Service / Services

- Services You Are Interested In or enrolled

Swimming Climbing Fitness Splash & Connect (Pool + Classroom) FitFun (Adapted PE session) Bespoke Programmes (Tailored sessions morning/afternoon) Camps / Crash Courses (Half Term and Summer Holidays) Online Counselling (Autistic Adults & Family members)

Client details & Support Form (Registration)

🏠 Parent / Guardian Information

👤 Participant Information

🏥 Medical needs

🧠 Behaviour Profile & Preferences

🗣️ Communication & Interaction Profile

🧩 Independence & Daily Participation

🕒 Service / Services