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 read?

    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:

    Can your child greet others? (eg. teachers/ friends)

    Let us know more:

    Does your child play with other children?

    Let us know more:

    Does your child know how to play social games, eg. chase the tail, hide and seek

    Let us know more:

    Does your child know pretend games?

    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?

    More about your child’s behavior problems:

    More about your child’s self-care ability and problems:

    Questions, Concerns or Special Circumstances you would like to share with us.