Online Enrollment Online Enrollment Form Child Name Parent's Name Child's Gender Child Age Mobile Number Your Email Does the child respond when his name is called out? Yes No Is the child able to make eye contact with an adult? Yes No Is the child able to follow simple instructions? Yes No Can a child give sustainable attention? Yes No Does the child walk steadily? Yes No Is the child able to speak? Yes No Is the child able to pronounce words with clarity? Yes No Does the child enjoy playing with kids of his/her age? Yes No Is the child involved in Aloof play? Yes No Is there any pre-diagnosis? Yes No Is there any motor difficulty the child is facing? Yes No Is the child able to answer open ended questions like (how was your day?, what all happened in school) Yes No Does the child know what to do with common things like a brush, phone, spoon? Yes No Does the child copy simple actions and words? Yes No Do you feel he has lost skills which he had once? Yes No Send
