Florida Keys Down Syndrome Educational Trust Inc. 501(c)(3) - Extra Curricular Activities Fund for DS Children
CHILD'S FULL NAME
DS CHILD'S D/O/B
SCHOOL ATTENDED
FULL ADDRESS/ZIP CODE/PHONE/EMAIL
MONROE COUNTY RESIDENT?
YES
NO
KARYOTYPE AVAILABLE?
YES
NO
DESCRIBE YOUR CHILD'S NEEDS
CHECK THE ACTIVITIES BELOW THAT WOULD SUIT YOUR CHILD'S NEEDS
PHYSICAL THERAPY?
YES
NO
SPEECH THERAPY
YES
NO
OCCUPATIONAL THERAPY
YES
NO
DOLPHIN SWIM THERAPY/HYPO-THERAPY (HORSE RIDING)
YES
NO
ATHLETIC TRAINING
YES
NO
DANCE THERAPY
YES
NO
RESPITE CARE
Yes
No
CLASSROOM ASSISTANCE
YES
NO
ART THERAPY
YES
NO
MUSIC THERAPY
YES
NO
MARTIAL ARTS ACTIVITIES
YES
NO
SWIM TRAINING
YES
NO
READING COACH/ASSISTANCE
YES
NO
LIFE SKILLS COACH/TRAINING
YES
NO
SPORTS THERAPY
YES
NO

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