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Private class information form

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What is the main reason or reasons you would like your Child/Teen to attend a private session?

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Please list your Child/Teens interests:

Has your Child/Teen ever had any surgery?
Has your Child/Teen ever had a physical injury requiring hospitalisation?
Does your Child/Teen have Asthma or Allergies
Does your Child/Teen have any physical limitations?
Does your Child/Teen have any sensory issues or sensitivities for example light, loud noises, smells, textures.
Does your Child/Teen experience Anxiety?
Does your Child/Teen experience Depression?
Does your Child/Teen lack confidence and self-esteem?
Additional information or areas you would like to focus on during these sessions.

Thank you for submitting!

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