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Pre-Program Questionnaire
Thank you for your interest in the Resilience Kit Program.
Please complete the form below so we can learn more about your child.
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www.resiliencekit.com.au/mental-health/privacy-policy/
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Child's name
*
Your answer
Child's age
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Your answer
Child's date of birth
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Your answer
Child's school and year group
Your answer
Your name
*
Your answer
Your phone number and best time to reach you
*
Your answer
Your email address
*
Your answer
Your suburb
Your answer
Please list any concerns you have about your child.
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Your answer
Is your child currently receiving any additional support?
*
Your answer
What are your child's strengths?
*
Your answer
What are your child's hobbies and interests?
*
Your answer
Is there anything else that you can think of that can help us understand where your child is at?
*
Your answer
What would you like your child to achieve by the end of the program?
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Your answer
How did you hear about us?
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Your Child's School
Referral from a GP, Psychologist or Other Health Professional
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