We'd love to have your child attend the Conductive Education classes we're offering.  The Conductor/instructor is provided by United Cerebral Palsy of Southern Arizona.  They are a registered non-profit organization, and they have provided a channel for the funding.

To reserve a space for your child takes two steps: 

 

Step ONE: click through here and pay the $375 reservation fee (which covers the tuition for the first week of class).


 

Or, send a check or money order for $375, made out to UCPSA, to:


Jodi Hansen
6531 S Owensboro Dr
West Jordan, UT 84084
Step TWO:  Fill out the questionnaire below, so that we can best prepare for your child's needs!

First Name *
Last Name *
Home Phone 
Street 
City 
State 
Zip 
Country 
Email Address *
What is the Child's name? 
Are there any medical problems or diseases in either the mother's or father's families, such as diabetes, siezure disorders, sight, hearing, or neurological problems? 
How many pregnancies has the mother had? 
Where is this child in the birth order? 
What are the ages of any siblings? 
What problems, if any, did the mother have during her pregnancy and delivery of this child? 
What treatments or medications were given during the pregnancy or delivery of this child? 
At what week of gestation was the child delivered? 
What was this child's birth weight? 
Describe the labor and delivery (i.e. easy, difficult, fast, slow, induced, C-section...) 
Did this child cry immediately upon delivery? 
 Yes     No
What were the Apgar scores? 
Was Oxygen administered to this child on delivery? 
 Yes     No
List any problems encountered or treatments administered after the delivery 
When was this child taken home from the hospital? 
List any medications the child has taken in the last year 
Did/does this child have any siezures? If so, when and how often? 
List any operations this child has had and the dates they occurred, to the best of your memory. 
At what ages did the child begin to lift his/her head, turn over, crawl, sit, stand, help with dressing? 
What assistance, if any, is needed for feeding and dressing? 
Is the child potty trained/able to use the toilet? 
Is the child able to speak? Does he/she use a communication device? 
Describe any treatments, medications, or therapy, if any, this child has received for his/her motor disorder. 
Please add any medical information you think would be valuable to us 
Describe the child's daily routine 
Who looks after this child? 
What are this child's favorite games, activities, toys, etc...? 
How does this child participate in family life? Does he/she have any chores or duties? 
How does this child move around the house? outside the home? 
Has this child ever participated in Conductive Education before? If so, where and when? 
Which activites do you think this child needs the most help to accomplish? (i.e. self-care, changing position, walking, eating, etc...) 
What do you think is most frustrating for your child? 
What goals do you have for your child? 
Is there any other information regarding this child's home and family life that you feel would be important for us to know? 
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