Child's Full Name *

Phone *

Guardian’s Full Name

Emergency Contact Name

Emergency Contact Phone Number

CHILD PROFILE

The more we learn about your kiddo, the more we can shape an experience that helps them shine at Mighty Minds.

Does the child(ren) have any special needs we should be aware of? *

Does the child(ren) have any medical conditions we should be aware? *

Does the child(ren) have any allergies we should be aware? *

What helps your child(ren) feel safe, supported, and confident in new environments? (e.g., knowing the schedule, having a buddy, gentle encouragement, sensory tools, etc.) *

Are there any specific challenges, fears, or sensitivities (emotional, social, or sensory) we should be aware of to best support your child(ren)? *

What are your child(ren)’s favorite activities or interests, and how do they typically connect with new people or animals?

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