Boundless Kids Intake Form

Thank you for checking out Boundless Kids! We can't wait to serve your family!

Your name *

Email address *

Phone number *

Child's Name *

Birthdate *

What are some things that your child loves/has interest in?

What are some activities and/or environments that might upset your child, and how can we help comfort them in those moments?

Please tell us about your child’s communication skills. Does your child use any assistive devices (walker, wheelchair, communication device)?

Please describe any adverse behaviors that we should be aware of and how they are being addressed at home or school.

Are there behavior plans or tools that you’d like to share with us to maintain consistency between home, school and church?

Does your child have allergies? (if yes, please elaborate)

Is your child prone to seizures? (if yes, please elaborate)

Please share a few of the things you love about your child and what makes them special.

Please include any additional information you’d like us to know about your child.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.