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Interest in joining Starfish Nipper Program
Please answer the following questions to support our recruitment and training for the dedicated helpers that will be volunteering to support the Starfish Nipper Program at Pt Leo SLSC.
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Starfish Nipper's Name and Date of Birth
*
First and last name
Date of Birth
Your answer
Parent/Guardian
*
First and last name
Your answer
Email
*
Your answer
Phone number
*
Your answer
Let us know about your child
*
Please describe their disability and the supports they will need to participate in the Starfish Nippers program
Your answer
Communication
My child is able to: (tick as many boxes as relevant)
Yes
Communicate verbally
Make eye contact
Understand verbal instructions
Understand non-verbal instructions (eg: hand gestures)
Yes
Communicate verbally
Make eye contact
Understand verbal instructions
Understand non-verbal instructions (eg: hand gestures)
Communication aids
My child uses communication aids
Yes
No
Auslan
Makaton
Compic
Board Maker
Other
Yes
No
Auslan
Makaton
Compic
Board Maker
Other
If another communication aid is used, please describe
Your answer
If your child shows frustration or distress, please let us know what strategies are successful in calming them
*
Your answer
Mobility
Never
A few times
Regularly
My child requires assistance to walk
My child has swum in the ocean
Never
A few times
Regularly
My child requires assistance to walk
My child has swum in the ocean
Clear selection
Water skills
Yes
No
Hold their breath underwater for 5 seconds
Tread water/float >1 minute
Dog paddle
Swim freestyle
Yes
No
Hold their breath underwater for 5 seconds
Tread water/float >1 minute
Dog paddle
Swim freestyle
Clear selection
With Swimming my child (tick all that are relevant)
Yes
No
is very competent in deep water
can swim undaided with a flotation devicce
cannot swim or does not like swimming
requires more than one assistant for support in the water
Yes
No
is very competent in deep water
can swim undaided with a flotation devicce
cannot swim or does not like swimming
requires more than one assistant for support in the water
Clear selection
Additional information: What does your child like doing?
Your answer
Please specify anything they do NOT like to do
Your answer
What approaches and qualities normally work best in a person supporting your child?
Your answer
Thanks for taking the time to complete these questions. Please feel free to leave any questions or comments here. Alternatively, you can email me at
starfish@pointleoslsc.com.au
I'll be in touch with you in the next few weeks.
cheers
Jane Starr
Your answer
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