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Introducing our new service

We are introducing a new service designed around fun, active therapy & motor learning for children aged 3-18, who have lost skills due to restricted access to school, therapy services & opportunities to be active.

The programme will consist of small group, weekly block sessions at the Craighalbert Centre, Cumbernauld and home learning, focusing on functional skills.

The sessions are designed to support sustained improvement and future resilience by building parental skills to support home learning between sessions and to reduce the chance of regression, hence each child will require to be accompanied in sessions by a participating parent who can also enjoy the fun.

We are now taking applications for our Spring programme. Closing date for phase 1 applications is 18th April 2021.

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* 1. Parent Contact Details

Name *

Address *

Address 2

City/Town

Post Code *

Email Address

Phone Number

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* 2. Child's Details

Name *

Address

Address 2

City/Town

Post Code

DOB *

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* 3. What activities does your child like / what motivates them?

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* 4. Has your child received a diagnosis?

Yes

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* 5. If yes please list

Current Challenges / Presenting Conditions

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* 6. Please give us details of movement and / or independence skills that your child has lost.

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* 7. Is this a new, longstanding or recurring challenge?

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* 8. Has your child previously received therapy for this challenge?

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* 9. What would your child / you hope to achieve by accessing our programme?

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* 10. What are your child's and your movement and / or independence priorities?

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* 11. Has your child mastered these skills in the past?

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* 12. If yes, how long has it been since these skills were lost?

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* 13. Why are these skills important to your child?

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* 14. Can your child work in a small group?

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* 15. What level of independence or need does your child have in each area?

	Independent	Some help	Full assistance	N/A
Access to toilet	Access to toilet Independent	Access to toilet Some help	Access to toilet Full assistance	Access to toilet N/A
Personal care after toilet	Personal care after toilet Independent	Personal care after toilet Some help	Personal care after toilet Full assistance	Personal care after toilet N/A
Dressing	Dressing Independent	Dressing Some help	Dressing Full assistance	Dressing N/A
Showering / bathing	Showering / bathing Independent	Showering / bathing Some help	Showering / bathing Full assistance	Showering / bathing N/A
Eating / drinking	Eating / drinking Independent	Eating / drinking Some help	Eating / drinking Full assistance	Eating / drinking N/A
Getting on / off chair	Getting on / off chair Independent	Getting on / off chair Some help	Getting on / off chair Full assistance	Getting on / off chair N/A
Getting in / out of bed	Getting in / out of bed Independent	Getting in / out of bed Some help	Getting in / out of bed Full assistance	Getting in / out of bed N/A
Making drinks / snacks	Making drinks / snacks Independent	Making drinks / snacks Some help	Making drinks / snacks Full assistance	Making drinks / snacks N/A
Getting in / out of car	Getting in / out of car Independent	Getting in / out of car Some help	Getting in / out of car Full assistance	Getting in / out of car N/A
Homework / school work	Homework / school work Independent	Homework / school work Some help	Homework / school work Full assistance	Homework / school work N/A
Leisure activities	Leisure activities Independent	Leisure activities Some help	Leisure activities Full assistance	Leisure activities N/A
Household chores	Household chores Independent	Household chores Some help	Household chores Full assistance	Household chores N/A
Understanding money	Understanding money Independent	Understanding money Some help	Understanding money Full assistance	Understanding money N/A
Taking responsibility for belonging (i.e. getting school bag ready)	Taking responsibility for belonging (i.e. getting school bag ready) Independent	Taking responsibility for belonging (i.e. getting school bag ready) Some help	Taking responsibility for belonging (i.e. getting school bag ready) Full assistance	Taking responsibility for belonging (i.e. getting school bag ready) N/A
Walking	Walking Independent	Walking Some help	Walking Full assistance	Walking N/A
Going up /down stairs	Going up /down stairs Independent	Going up /down stairs Some help	Going up /down stairs Full assistance	Going up /down stairs N/A
Communication	Communication Independent	Communication Some help	Communication Full assistance	Communication N/A

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* 16. Does your child currently use equipment or adaptations?

	Yes	No
Lower limb splints	Lower limb splints Yes	Lower limb splints No
Hand splints	Hand splints Yes	Hand splints No
Hoist equipment	Hoist equipment Yes	Hoist equipment No
Standing frame	Standing frame Yes	Standing frame No
supported seat	supported seat Yes	supported seat No
Bathing equipment	Bathing equipment Yes	Bathing equipment No
Toilet Equipment	Toilet Equipment Yes	Toilet Equipment No
Therapy equipment	Therapy equipment Yes	Therapy equipment No
Wheelchair	Wheelchair Yes	Wheelchair No
Other mobility Equipment	Other mobility Equipment Yes	Other mobility Equipment No

Other (please specify)

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* 17. How did you hear about us?

Social Media

Website

Signposted by professional

Signposted by School

Signposted (other)

Friend/Family

Other (please specify)

Thank you for taking the time to complete this form. A member of our team will contact you to discuss your application. If you would like to discuss any of the questions further please contact us at reskill@craighalbert.org.uk or call 01236 456 100.