WEEKDAY PROGRAMME PARTICIPANT PROFILE 2022

Student Name

Date of Birth

Primary Carer's Name

Emergency Contact Number

2nd Contact Number

Email Address

Likes

Dislikes

Hobbies

Medical Diagnosis

Underlying health and medical issues we should be aware of: Underlying health and medical issues we should be aware of: Allergies Epilepsy Hearing Vision Other

Other health and medical issues

Which medications are required?

Assistance required with medications: Assistance required with medications: Yes No

Permission to give Permission to give Panadol Aspirin Ibuprofen

Any concerning behaviors we should be aware of? Please describe, include triggers and recommended behavior management/strategies:

Please note that we aim to encourage healthy food choices throughout the day, but we are guided by your instructions. Food Allergies/restrictions:

How will the student travel to & from our programme? Does the student have your consent to leave our premises independently – e.g. to walk to bus stop/train station/shop?

What is the family structure and what are the student's living arrangements?

What day to day activities is the student involved in, besides BAM. Work/volunteering/day services:

Literacy: Please give us an idea of your student’s ability to read instructions/scripts/lyrics:

Healthcare Card Number

Companion Card Number

Ambulance Victoria Number if applicable:

GP (Name and Clinic details)

Preferred Hospital

Please tell us anything else you’d like us to know about your student. Likes/dislikes, strategies for helping the student, or things you are wanting to encourage/discourage – anything at all that will help us get to know the student.