registration form for daytime activities

Move2Skool registration form:

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Aanmeld en contactgegevens

Name of the child

Date of birth

Sex

BSN number

Health insurance/policy number

Address

Name of parents/guardians

phone number

Address

Marital status of parents

Who has authority?

Family situation

Applicant details

Function

phone number

Veldlabel

Overige informatie/ Ontwikkelgebieden

Diagnose

Medicines/ allergies

Hearing / vision

Self-sustainability

Concerns and strengths development areas

Socially emotional

Game development

Cognitive

Motor

Speech-language development

Explanation of development delays

Is the child sensitive to stimuli?

Can the child function in a small group?

Child expresses himself externalizing

Child expresses himself internalizing

What is working (possibly with support) with regard to the development areas

Structure / routine

Structuur/ routine

Within Move2Skool we work with a tailor-made daily schedule. Is a daily schedule/routine used at home (or previous childcare)?

If so, please bring it with you to the intake or send it to info@move2skool.nl

Adaptability: Is the child able to cope with sudden changes in the daily routine?

If not, how does this manifest itself?

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Doelen (wat willen we binnen Move2Skool oefenen)

Wishes regarding the goals

Veldlabel

Veiligheid

There is a risk of running away?

Putting objects in mouth?

Hits/kicks around himself or others?

Hurts himself?

Frequently/sometimes shows emotional moods

Expression of emotional moods

How do the above-mentioned emotional moods express themselves?

What has a calming effect?

What doesn't work?

Who to call in an emergency?

Who can pick up the child?

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Lopende zorg

Is there support/care from other organizations/providers?

Move2Skool is a bridging place and a future perspective is therefore necessary. Is there a prospect of a follow-up location?

Where is your child registered or on the waiting list? Can you tell us something about the waiting time?

Agreements about the start date

Get used to appointments

Other wishes of parents/guardians

Will your child use taxi transport?

Particularities

Datum

Place of signature

Call us

31180234081AdresInfo@move2skool.nl

Working hours

Mon - Fri: 9:00 am - 6:00 pm
Sat - Sun: Closed

+31180234081 info@move2skool.nl

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Move2Skool registration form:

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