Helping Hands Interest Form

First Name

Last Name

Do they have a mobile phone or email?

Birthday

Gender

Are they a member of Concord?

Address

Primary Disability

Skills/Interests/Hobbies

What motivates them?

Do they have any sensory aversions?

Do they use a communication device?

Can they communicate their wants and needs?

Please explain further if needed:

How well do they engage with peers?

How well do they engage with technology?

First Name

Last Name

Email

Mobile Phone

Are there any siblings at home?

What activities does your family enjoy together?

Do both parents work?

Have you ever attended Joni & Friends Camp?

Work Entry