form_respite night sign ups Name of parent * First Name Last Name Email Address * Phone * (###) ### #### Name of child * Age of child * We will be serving Pizza (pepperoni/cheese), Veggies, Cookies, and some sort of snack (Goldfish, fruit snacks, granola bars). Does your child have any of the following allergies? * Dairy (we will be serving pizza for dinner) Gluten Carrots Celery Broccoli Bell pepper None Other Does your children have any disabilities? * ADHD ADD Autism Sensory Processing Disorder Anxiety RAD None Other What behaviors can we expect from your kiddo? * Excessive eating Avoids/Restricts food Aggressiveness with other kids Aggressiveness with adults Lying Stealing Self harm Destruction of property Sensitivity to noise None Other What else should we know to better ensure your child has a fun time? * Thank you!
