Student Profile

Please fill out completely so that we can get to know your student prior to the first class.

Student's Full Name

First Name

Last Name

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone Number

(###)

###

####

Student's Age

Student's DOB

YYYY

City, State

Siblings & Ages:

Pets:

Favorite Activities:

List any previous experience in the performing arts, fine arts and/or yoga:

Does your student have a Down syndrome?

Yes

List any other diagnoses, orthopedic injuries and/or surgeries we should know about:

List any other medical issues we should be aware of:

How does your student communicate?

Does your student have any triggers?

Does your student demonstrate any aggressive behaviors or have any other behavioral concerns? If yes, please explain:

For our in-person classes, how does your student feel about physical touch in regards to hands on adjustments? For those attending Zoom classes, please feel free to still answer this question as it will further guide your instructor on how to better engage with your student.

What is the best way to soothe your student?

What are your goals for your student regarding their overall experience in our class?

Is there anything else you would like us to know about your student and/or family?

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