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Naperville CompassKids
Inclusion and Sensory Room
Before your first weekend visit:
Fill out this form with information about your child
A CompassKids team member will be in touch to discuss details specific to your child.
Schedule your first visit.
Work Entry
Required
Parent's Information
Parent/Guardian #1's First Name
Parent/Guardian #1's First Name is required.
Parent/Guardian #1's Last Name
Parent/Guardian #1's Last Name is required.
Parent/Guardian #1's Phone Number
Parent/Guardian #1's Phone Number is required.
Parent/Guardian #1's Email
Email address is not valid
Parent/Guardian #1's Email is required.
By checking the box below, I consent to receiving texts from The Compass Church.
I want to add Parent/Guardian #2 information
Child's Information
Child's First Name
Child's First Name is required.
Child's Last Name
Child's Last Name is required.
Child's Date of Birth
Child's Date of Birth is required.
Explain your child’s diagnosis, medical condition, or learning differences.
Explain your child’s diagnosis, medical condition, or learning differences. is required.
Is there a medical issue we should watch for (i.e. seizure disorder, allergies, chemical sensitivities, etc.)?
Is there a medical issue we should watch for (i.e. seizure disorder, allergies, chemical sensitivities, etc.)? is required.
How does your child communicate (i.e. words, phrases, sentences, babbles, gestures, sign language, AAC device)? Please explain.
How does your child communicate (i.e. words, phrases, sentences, babbles, gestures, sign language, AAC device)? Please explain. is required.
Describe things your child can do independently.
Describe things your child can do independently. is required.
Does your child need assistance going to the bathroom? Please explain.
Does your child need assistance going to the bathroom? Please explain. is required.
What interests or hobbies does your child have? How can we connect with them on a personal level?
What interests or hobbies does your child have? How can we connect with them on a personal level? is required.
Are there things your child has difficulties with or dislikes that we should be aware of? Are there situations that will trigger a negative response?
Are there things your child has difficulties with or dislikes that we should be aware of? Are there situations that will trigger a negative response? is required.
If your child is triggered by something, in what way do they tend to respond (i.e. physically, vocally, withdrawal, elopement, etc.)? Please explain
If your child is triggered by something, in what way do they tend to respond (i.e. physically, vocally, withdrawal, elopement, etc.)? Please explain is required.
Should your child become agitated or frustrated, what best calms him/her?
Should your child become agitated or frustrated, what best calms him/her? is required.
Please feel free to share any additional information that you think would be beneficial to us in serving you and your family.
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