fancy-membership fancy-stage fancy-tickets location up phone email facebook twitter

Student Questionnaire

Student Questionnaire for Children with Special Needs

This questionnaire is meant to assist The Rose Theater staff in creating the best possible class experience for children with autism and other specialized needs. Please complete those sections that are pertinent to your child.
    (Please check all that apply)
    In answering these questions, please keep in mind how your child responds to new situations, new people, and other qualities of the settings. Please check only one.
  • COMMUNICATION

    In the following sections, please check all statements that describe your child. Please answer thoroughly, giving examples where needed.
  • SELF HELP SKILLS

    Please indicate and explain whether your child can express the following concepts:
  • BEHAVIORS

    Please indicate how often, if ever, your child exhibits the following behaviors and the consequences:
  • EMOTIONAL RESPONSES

  • SENSORY TRIGGERS

    Please describe your child's sensory triggers.
  • (include adverse reactions to specific colors, favorite colors)
  • The Rose Theater's Touching Policy

    Please share the following with your child.