CHILD PROFILE
School Holiday Program Child Profile 2013
HISTORY
Does your child have a case manager? If yes, record name and organisation.
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What other services does your child access?i.e. Gateways, Scope etc
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What is your child's diagnosis/condition/s and/or additional need/s?
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Does your child use any specialised equipment or aids? If yes please list equipment.
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MEDICAL
Does your child have Anaphylaxis? Yes No
If yes, please attach an action plan from your Doctor.
Does your child have Diabetes? Yes No
If yes, please attach an action plan from your Doctor.
Does your child have Epilepsy? Yes No
If yes, please attach an action plan from your Doctor.
Does your child have Asthma? Yes No
If yes, please attach an action plan from your Doctor.
Is your child taking any regular or ongoing medication? Yes No
If yes, list medicine
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Times medication is given:______
Are there any symptoms or side effects of medication? Yes No
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Does your child have any known allergies? Yes No
If yes please list:______
GENERAL INFORMATION
What level of support needs to be provided to your child, and for what activities?(1:1 for parts of the day; 1:1 at all times; blends in with a small group)
Details:______
What level of supervision does your child require?
Constant close supervision
Intermittent supervision
Can be left alone
Details:______
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Is there a possibility that your child may attempt to leave the building without an adult / run away during an excursion? Yes No
What might be the causes? ______
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CARE NEEDS
Please provide details unless your child is independent in each area.
Personal Care – Toileting
(Is your child able to indicatehis/her needs and what level of assistance is required / equipment used?
i.e.: needs reminding to go to the toilet; incontinent at times etc
Incontinent Yes No
Wears nappies Yes No
Independent toileting Yes No
Wipes own bottom Yes No
Independent with routine Yes No
Independent dressing Yes No
Manages own hygiene Yes No
Turns taps on and off Yes No
Onset of puberty Yes No
Details:______
Support required:______
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Personal Care - Dressing
Does your child require assistance with dressing / undressing? Important for toileting and swimming excursions.
Able to undress self Yes No
Able to dress self Yes No
Understands order of clothing Yes No
Understands climate appropriate dressing Yes No
Able to complete tasks for buttons / zips Yes No
Details:______
Support required:______
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MEAL / SNACK TIMES
Is your child able to indicate their needs and what level of assistance is required / equipment used? i.e.: needs reminding to use a fork;is ableto get a drink from school bag; unable to feed self etc.
Able to feed self with spoon and fork Yes No
Able to unwrap own lunch and peel fruit Yes No
Drinks from a cup Yes No
Staff to prompt fluid intake Yes No
Understands lunch routine Yes No
Follows lunch routine in sequence Yes No
Easily distracted at routine time Yes No
Needs supervision Yes No
Manages own hygiene Yes No
Details:______
Support required:______
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Strategies used:______
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MOBILITY
Is your child able to indicate their needs and what level of assistance is required / equipment used?
Wheelchair Yes No
Frame Yes No
Requires hoist for lifting Yes No
Able to crawl independently Yes No
Independent with stairs Yes No
Unable to walk long distances Yes No
Details:______
Support required:______
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COMMUNICATION
Is your child able to indicate their needs and what level of assistance is required / equipment used?
Communicates / speaks clearly Yes No
Speech can be understood Yes No
Communicates well with others Yes No
Primary language spoken and/or understood - English Yes No
Secondary language spoken and / or understood Yes No
Communication aids required Yes No
- If yes what aid is used?
Makaton Yes No
Compic Yes No
Board Marker / cards / pictures Yes No
Other Yes No______
Understands verbal instructions Yes No
Follows through with instruction Yes No
Makes eye contact Yes No
Understands gestures Yes No
Uses eye contact Yes No
Details:______
Support required:______
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Strategies used:______
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PHYSICAL
Level of assistance required to support your child. Fine Motor Skills: (your child is able to, etc)
Can pen doors: Yes No
Can unlock doors Yes No
Able to write Yes No
Able to tie shoe laces Yes No
Able to cut with scissors Yes No
Able to participate in craft activities Yes No
Needs encouragement to engage in task Yes No
Details:______
Support required:______
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Gross Motor Skills
Can climb Yes No
Has good balance Yes No
Level of co-ordination ______
Can play bat and ball games Yes No
Can participate in team sports Yes No
Details:______
Support required:______
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SOCIAL / EMOTIONAL
How does your child respond in social situations? i.e. solitary play, outgoing etc
Shy in new environments Yes No
Understands rules and boundaries Yes No
Engages in play Yes No
Able to share and take turns Yes No
Able to sit for a bus trip Yes No
Able to sit on a mat during meeting times Yes No
Able to sit through a movie at the cinema Yes No
Able to sit through meal times Yes No
Details:______
Support required:______
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What strategies/routines do you use to encourage and engage your child?
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COMMUNITY SAFETY
Your child’s heath, safety and wellbeing are our priority. Please provide detailed information to assist staff in managing all situations.
Awareness of Danger / DetailsEXAMPLE:
Absconds
Roads / EXAMPLE
1. Must hold child’s hand at all times in public – runs away.
2. Must lock all doors at home, wanders off down the street, unnoticed by parent.
Child needs reminding to stop and look for cars before walking across the road. Then they understand the concept.
Roads / Knows to “Stop and Look” at roads Yes No
Heights / Able to climb equipment Yes No
Is fearful Yes No
Strangers / Understands concept of stranger danger Yes No
Wandering / Absconding / Will attempt to leave venue/ groupunaccompanied? Yes No
Behaviour / Kicking Yes No If yes what predicts this behaviour:
Hitting Yes No i.e. Frustration, anger, boredom
Spitting Yes No
Swearing Yes No
Water / Enjoys water play Yes No
Can swim Yes No
Enjoys being in water Yes No
Hates the feeling of wet clothing Yes No
Self Harm / When frustrated, annoyed? Yes No
Other i.e. dogs, crowds, noises, etc / Please list details if events/places cause anxiety
Details:______
Support required:______
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Strategies used______
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Does your child display challenging behaviour? Yes No
Example:
Behaviour Bites other children
Reasons Seeking attention from staff / not wanting to share equipment
Consequence:At home child is sent to bedroom for 10 minutes - time out.
At school child is spoken to in private area and given reasons why the behaviour is notappropriate, 5 minutes time out parents notified.
Details:______
Consequences that have been used and work ______
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Strategies for staff: ______
Does your child have a behaviour management plan at home / school? Yes No
If yes, please attach
Does your child become frustrated? Yes NoWhat are the triggers?
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How does he/she express frustration?
With words Yes No
Screams Yes No
Bangs head Yes No
Hits wall Yes No
Bites Yes No
Throws things Yes No
Details:______
Successful consequences that have been used: ______
Strategies used:______
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Does your child show concern for others? Yes No
Any special security objects (eg. blanket, toy) when distressed?
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Any further comments about your child’s social and emotional needs
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Interests
Are there any activities that your child particularly enjoys or has a special interest in?
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Are there any other special considerations staff need to be aware of, to ensure the participation of your child in all activities planned?
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What are your goals for your child’s participation in the School Holiday Program?
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What is a calming activity for your child?
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HOW TO KEEPSAFE
Please provide detailed information. This page will be placed on staff notice boards for easy access
If my child… / please follow the following steps:ABSCONDS WANDERS
RUNS AWAY
USES INAPPROPRIATE LANGUAGE
HITS
PUNCHES
KICKS
BITES
GOES ON EXCURSION
The best person to contact if my child is distressed is:
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The best activity for child when distressed / anxious is:______
The best thing to say to my child to calm him / her down is:
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Any further comments?
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School Holiday Program Child Profile 2013