I train my child Note: The program (I train my child) is a program offered to parents with autism spectrum disorder. Note: the absence of a medical report proving the diagnosis of autism spectrum disorder may disqualify the applicant from joining the program The program will be delivered via Google Meet child name * child name child first name child first name child last name child last name child date of birth * child age Has your child been diagnosed with autism spectrum disorder? * yes no Do you have evidence that your child has been diagnosed with autism spectrum disorder (medical report, for example)? * yes no please upload diagnose / medical report * Drop a file here or click to upload Choose File Maximum file size: 2MB Has a service been received through our center previously? * yes no Does your child communicate with others using two to three word sentences? (Example: “a big ball”, “I want water”, “Where did dad go?”). * yes no Parent/guardian information (trainee) The guardian (trainee) is the one who will receive training from the specialist via video broadcast, apply instructions and strategies with the child with autism spectrum, and provide feedback and responses to the specialized trainer. Are you the one who will train the child? * yes no your name * relative relation * motherfatherbrother/sisteruncleauntgrand parentother relative relation mobile number * email * صورة الهوية الوطنية * Drop a file here or click to upload Choose File Maximum file size: 2MB please upload family card * Drop a file here or click to upload Choose File Maximum file size: 2MB do you have internet at home? * yes no I would like to receive training in order to develop the skills of my child with autism in the field of: * Communication and social interaction Early Intervention Managing behavioral problems Self-care skills / toilet training Sensory motor skills or feeding skills (occupational therapy program) Are you able to commit to attending remote training sessions, applying and providing responses for a period of (one session per week / for 12 weeks)? * yes no Region of residence at the moment * RiyadhMekkaAl-MadinaQasimEastern ProvinceAsirTaboukHaelNorthern bordersNajranJazanAl-BahaAl-Jouf City of residence * I prefer to be trained by a professional * man women no preference I would like to receive training during this time * 8 - 10 am 10 - 12 am 12 - 3 pm I allow the Autism Center of Excellence to photograph my son / daughter (photo / video) in order to use them in various means of communication and activities of the center, whether inside or outside the center. Some parents and specialists may ask about the child's name. I allow that my first child's name may be mentioned to comment on the photo. This permission is allowed from the date mentioned when filling out the form. And I know that I can withdraw this permit at any time, and I will not hold the Autism Center of Excellence responsible for the previously taken photos. * I Agree هل تسمح بمشاركة مقاطع فيديو لك مع طفلك لهدف التدريب ؟ * أوافق Captcha ارسال If you are human, leave this field blank.
