Participant Information Inclusion Form

Fields marked with an * are required

Name*
First Last
Today's Date*
MM slash DD slash YYYY
Date of Birth*
MM slash DD slash YYYY
Disability/Diagnosis*
Things that I am good at/like to do:*
Things that I am not so good at/don't like to do:*
I communicate by using:*
Help me understand what you want me to do by:*
My social skills with my peers are:
Things that make me happy:*
Things that make me sad or mad are:*
You can tell that I am frustrated/upset when I:*
Things you can do to help me calm down:*
Behavior management techniques that work for me:*
My swimming skills are:*
Medical issues for me are (i.e. seizures, medications, etc.):*
My goals for the program are:*
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