Forms and Datasheets

Program Checklist

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Mark if + or -

Program Tracking

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Mark if + or -

Social Questions Target List

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Mark with date

Target List Form

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Tracking List for _________________

Therapist Timesheet

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Name: ________________________________ Round time to nearest 5 min.

Tracking List Form

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Enter check mark

Video Tape Permission

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

In order to video tape my son, CK, I must have permission from all parents of children that may come in contact with CK during video taping. Video taping occurs to teach parents of CK and train Aides how to better teach CK to interact with his peers.

Please sign the form below. If you have any questions about video taping, CK, or autism, please call, email, or visit our website:

John Doe

Home 555-1212

Work 555-2121

CK's team appreciates your interest and cooperation in helping,

John Doe

Consent for Photographs, Movies, or Television

I, the undersigned, hereby authorize photographs and/or movies of ____________________________________(name of participant) by the representatives of the above-named program or other designated persons to be viewed by the above-named program staff in contributing to the educational development of this staff in the advancement of teaching techniques and program activities.

_________________(date)

_______________________________(signature of participant - if applicable)

_______________________________(signature of parent/guardian)

Vitamin Log

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

Mark with # of pills to take

Sample Help Wanted

Kathy — Thu, 28 Jun 2007 13:36:52 -0700

WANTED

Someone to make a difference in the life of a child with autism.

Tutors needed for sessions between 9am and 4pm weekdays in Corvallis. (Minimum of 6 hours/week) Weekends/other hours negotiable. Only requirements are patience, big heart, and willingness to learn. Continual training provided. 6 month commitment needed. Pay starting at $8 per hour (depending on experience). Call John Doe. Home 555-1212, work 555-2121. Come join our team!

http://www.kathyandcalvin.com

Maintenance Checklist

Kathy — Thu, 28 Jun 2007 13:36:51 -0700

Correct = +, Incorrect = -