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CADS Enhancement Centre Intake Form
Please attach:
a. 3 copies passport size photographs of student (new student)
b. 1 copy each passport size photograph of parents (new student)
c. 2 copies of birth certificate (new student)
d. 1 copy each parents’ (new student)
e. A copy of student’s medical report

STUDENT
  1. Name
  3. Diagnosis
  5. Date of Birth
  7. Sex
  9. Birth Cert. No.
  11. No. of Siblings
  13. Independent FeedingToilet trainingMobility
  15. Address
PARENTS/GUARDIAN

Relation FatherMother

PRESENTING PROBLEM


Please write a brief description of the child for each of the following areas.

OTHER INFORMATION

Please write a brief description of the child for each of the following areas:

  • What disciplinary techniques do you usually use when your child behaves inappropriately? Place a check next to each technique that you usually use. There is also space for writing any other disciplinary techniques that you use.
    Ignore problem behaviorTell the child to sit on chairScold childSend child to his/her roomSpank childTake away some activityThreaten childReason with childRedirect child’s interestDon’t use any techniques



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