Your Student's Name
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First Name
Last Name
Student's Birthdate
*
MM
DD
YYYY
Your Name
*
First Name
Last Name
Your Relationship to Student
*
Your Email Address
*
Your Phone Number
*
(###)
###
####
Mailing Address for your Student
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please Select Your Family's First Choice
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Please note: this does not guarantee registration in the class. Registration will be confirmed by AIM Staff via Email before the session begins.
Students are encouraged to take class independent of caregivers; if your student has a medical need that necessitates your presence, please let us know you plan to stay?
What kind of music/musical artist does your student like to listen to? Do they have a favorite song?
Does your student use any mobility equipment such as a wheelchair, walker, etc.? If yes, please describe.
How might your student express their needs? (water, bathroom, rest, etc.)
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Is there anything teachers ought to know about your student to help keep them and fellow students safe while in class?
Does your student have any medical conditions? If yes, please share what staff will need to know to help your dancer in class.
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Does your student have any sensitivities? What, if anything, helps?
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Please share a bit about your student's school setting, if applicable.
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Does your child work with an aide in class? Is your child in a self-contained classroom or part of an inclusion model at their school? What does your child like best about school?
How does your student show they are getting dysregulated, overwhelmed, or distressed? What, if anything, helps?
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What do you hope your student gains from this class experience?
Lastly, please share anything else you would like us to know about your student that will help us support them for a positive class experience.
We would especially love to know about anything related to physical, medical, intellectual, sensory, social-emotional, or behavior-related disabilities or sensitivities.
Zip Code
*
Which of the following best represents your Student's race?
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Please check all that apply
If Other, please specify
Does your Student identify as Hispanic/Latinx?
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What Language do you prefer to speak at home?
*
If Other, please specify
What Gender does your Student identify as?
*
If Self-describes in another way, please specify
