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Life Skills Camp Questionnaire

Please fill out the following form and share as much information as possible to help us better understand and support your needs.

First name

Last name

Email

Phone

Which age range best describes your child?

Ages 5-8

Ages 8-13

Ages 13-18

Ages 18 and Up

Grade Level

Does your child have any formal diagnosis (e.g., autism, ADHD, learning disabilities, etc.)? If yes, please provide details. If not, feel free to indicate 'none

Academic Information:

Add your text

What subjects does your child need help with? (Select all that apply)

Reading

Writing

Money Math

Traditional Math

Other

Do you prefer your child to learn math using a calculator, or would you like them to focus on traditional methods?

Yes

No

What are the top 3 life skills you would like your child to focus on first? Please select the skills that are most important for your child to work on in the immediate future.

Meal Planning

Budgeting

Cleaning

Executive Functioning Skills

Vocational Skills

Life Skills

Daily Routine

Community Safety

Cooking

Kitchen Safety

Emergency

Time Management

Social Skills

Travel Skills

Household Chores

Self Advocacy

Health

Financial Literacy

What teaching style has worked well for your child in the past?

Visual

Auditory

Hands-on

Are there any daily living skills or tasks your child struggles with that you’d like us to support them on during camp?

How independent is your child in completing household chores or managing personal tasks?

What are your child’s strengths and areas where they need additional support?

How comfortable is your child in the kitchen? (e.g., using knives, operating kitchen appliances, following instructions)

What are your child’s current cooking or life skills experience? (Have they ever helped in the kitchen, for example?)

What are your goals for your child’s development in life skills by the end of the camp?

Does your child have any social challenges that we should be aware of when planning group activities?

Does your child require one-on-one assistance or accommodations during activities?

What are your child’s strengths and areas where they need additional support?

How does your child typically respond to structured activities and routines?

What are your child’s current cooking or life skills experience? (Have they ever helped in the kitchen, for example?)

What are your goals for your child’s development in life skills by the end of the camp?

What are your long-term goals for your child’s future?

Do you envision your child living in an independent living facility or group home, or do you see them living independently in the future?

Is there anything else you would likfe to share about your child?

Building Independence Through Learning

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919-332-0760

erika@pictureperfectlc.com

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