Little Red Playhouse / Petite Maisonnette Rouge

Please fill out the following form so that a member of our team can get back to you with the information you need as quickly as possible. All information provided remains confidential. You will receive a confirmation by email.

Veuillez remplir le formulaire ci-dessous pour qu'un membre du personnel puisse vous fournir toutes les informations demandées le plus rapidement possible. Toutes les informations resteront confidentielles. Vous recevrez une confirmation par email.

Guardian/Parent

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Relationship

First name *

Last name *

Preferred pronouns

Email *

Mobile *

Zip/Postal code *

Other guardian/parent

Relationship

First name

Last name

Email

Mobile

Child Name

First name *

Last name *

Gender

Date of birth *

Desired Date of Programming Entry *

What language(s) does your child understand? *

English French

Other

What language(s) does your child speak? *

English French

Other

Does your child have any medical or developmental conditions or diagnosis we should know about? *

No Yes Suspected but awaiting diagnosis

Medical / Developmental Conditions: *

Please upload any relevant documents

Anything that may help us get to know your child better, such as: progress reports from previous programming/school, diagnosis, service reports or updates.

Anything else you'd like to share with us about your child or family that will help us get to know them or your goals for them?

Which programming are you interested in? *

Select all Clear all

Preschool

8:30 - 13:00

Afternoon Playgroup Afternoon Nap Social Skills Program 1:1 Early Intervention

Therapeutic programming based on the principles of VB-ABA

Coco's Camp

summer-only preschool programming for children ages 2-6 (limited space)

Camp Next Steps

for school aged children, already in the elementary school system, typically ages 6-12
*please note that Camp Next Steps is not operating summer 2024

This section is for families interested in Camp Next Steps, programming is typically designed and reserved for children who have already entered the elementary school system and are looking for a smaller structured environment with specialized programming and staff for neurodivergent children ages 6 - 12.

What school is your child currently enrolled in? | Dans quelle école votre enfant est-il/elle actuellement inscrit? *

What kind of school setting is your child currently enrolled in? | Dans quel type d'école votre enfant est-il actuellement inscrit?

Integrated in typical classroom / Intégré dans une salle de classe typique Integrated in typical classroom with aide/ Intégré dans une salle de classe typique avec auxiliaire de vie scolaire Welcome Class / Classe d'acceuil Closed ASD class Specialized School

Other

What grade is your child currently in? *

Can you tell us anything about their school experience so far?

Has your child attended summer camp before? *

Yes No

If yes, please tell us which camp and how that experience was.

This section is for families interested in our preschool programming, typically for children ages 2-6.

Is your child currently enrolled in another program/daycare/preschool elsewhere? / Votre enfant est-il/elle déjà inscrit dans un autre programme ailleurs? *

Yes No

Guardian/Parent

Other guardian/parent

Child Name

Desired Date of Programming Entry *

What language(s) does your child understand? *

What language(s) does your child speak? *

Does your child have any medical or developmental conditions or diagnosis we should know about? *

Medical / Developmental Conditions: *

Please upload any relevant documents

Anything else you'd like to share with us about your child or family that will help us get to know them or your goals for them?

Which programming are you interested in? *

What school is your child currently enrolled in? | Dans quelle école votre enfant est-il/elle actuellement inscrit? *

What kind of school setting is your child currently enrolled in? | Dans quel type d'école votre enfant est-il actuellement inscrit?

What grade is your child currently in? *

Can you tell us anything about their school experience so far?

Has your child attended summer camp before? *

If yes, please tell us which camp and how that experience was.

Is your child currently enrolled in another program/daycare/preschool elsewhere? / Votre enfant est-il/elle déjà inscrit dans un autre programme ailleurs? *

If yes, please tell us where and what that experience was like for them?