Application Form

Child Profile Form

    Parent name*

    Email*

    Tel. :*

    Residential City*


    Is this your first time to join our event?*
    YesNo

    How did you know about AP*

    Child Profile Form

    Please submit the child's latest assessment report (1st page only, within 1MB)*

    Please submit a recent photo of your child within 3 months(within 1MB)*

    Child’s Information

    Child Name:*

    Sex:*

    Day of birth:*

    Mother Language:*

    Does your child attend school?(If applicable)

    Grade Level:

    No. of days a week:

    School timetable:

    Type of classroom:

    Current services / treatments being provided (ABA at home or school, Speech, OT etc.) :

    Language Ability (please select the best answer)

    How many words a sentence*

    Words knew

    Can your child response to you?*

    Let us know more:

    Can your child take initiates to ask for something?*

    Let us know more:

    Can your child take initiates to say his/her opinions?*

    Let us know more:

    Can your child answer the below questions? (You May Choose More Than One)*
    Who…?why…?where…?How…?None of the above

    Let us know more:

    Can your child ask the below questions? (You May Choose More Than One)*
    Who…?why…?where…?How…?DepictionNone of the above

    Let us know more:

    Social Skill & Interest (please circle the best answer)

    Eye contact*

    Can your child express his/her social needs by words/body language?*

    Let us know more:

    Can your child stay alone without parents?*

    Let us know more:

    What kind of toys, game or activities your child like to play or do in his/her free time?*

    Problem Behaviors & Self-care Ability

    Does your child have self-stimulating behavior?*

    Let us know more:

    Can your child go toilet by himself/ herself?*

    If yes, how he/she show you the needs to go toilet?

    Does your child have picky eating problem?*

    If yes, what he/she don’t like to eat?

    Which 3 problem areas from your child you want us to tackle?*