Client details & Support Form NEW

🏠 Parent / Guardian Information

Name Relationship to Participant Phone Email Address Address Postcode

👤 Participant Information

Name Date of Birth Gender School / College / Residential Does the participant have an EHCP? EHCP (file) Is the participant supported by a Social Worker?

Yes No Not sure

If yes, please provide Social Worker name & Email

What are the participant's motivators or favourite activities?

For example: toys, activities, topics, rewards, sensory preferences, or anything that helps them feel engaged and comfortable.

What does the participant dislike or tend to avoid?

For example: specific activities, environments, sounds, interactions, or triggers that may cause discomfort or distress.

🏥 Medical needs

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

🗣️ Communication & Interaction Profile

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

Mainly communicates through behaviour Gestural or non-verbal cues (e.g. pointing, taking adult to item) 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

How does the participant best understand instructions? Preferred Communication Strategies That Work Well

Please describe any strategies, prompts, or systems that have worked successfully to support understanding and interaction

🧩 Independence & Daily Participation

Mobility & Physical Independence Personal Care

Fully independent (e.g. toileting, dressing) Needs physical assistance or supervision

Task Engagement

Can follow a simple routine independently Needs 1:1 support to complete most activities

Transitions & Flexibility

Adapts easily to change Struggles with unexpected changes or waiting time

Risk Awareness & Safety

Understands basic safety rules No awareness of danger – needs constant supervision

Anything else we should know about?

Client details & Support Form (Registration)

Registration Form

🏠 Parent / Guardian Information

👤 Participant Information

🏥 Medical needs

🧠 Behaviour Profile & Support Preferences

Known Triggers (what might cause distress or dysregulation)?

Strategies that help regulate?

🗣️ Communication & Interaction Profile

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

🧩 Independence & Daily Participation