Page 1 of 1

The Child We See- Waitlist Application

Thank you for joining the waitlist for The Child We See program.
I have intentionally built this program so that all children feel seen and heard. In order for them to get the very best out of it I ask if you could complete this application on their behalf.
I have intentionally made the cohorts small and will be only hosting 3 cohorts a year. The application will help me to understand the needs of your and to make sure that we are the right fit for each other as this is very important.
This should take no longer than 15 minutes to complete, the more detail I have the better support I can give.
Everything shared is confidential and is only used to decide if this program is the right fit for you.
Applications should be completed by a parent or legal guardian.
The application is broken down into 3 sections please ensure that all questions are answered. If you are not sure how to answer a question, its ok to state "not sure".
Thank you in advance

Part 1: About you

Your full name?

Relationship with child

Email Address

Phone number (Add area code)

Country you live in

Part 2: About your child

Your child's name

Date of Birth

Who does your child live with?

What does your child enjoy and what are they good at?

How would you describe your Childs character?

Part 3: What's been happening?

What made you look for support for your child right now?

How long has it beeping happening for?

Where do you notice it most?

Please state for other:

What did you notice in your Childs behavior, movement and body?

Have you spoken to your child's school, what is their feedback?

What would be a good outcome look like for your child after 12 weeks?

Part 4: Support so far

Has your child had counselling, therapy or other support before? If yes, what was helpful or not?

Is your child currently seeing any other professional such as a counsellor, psychologist, psychiatrist or paediatrician?

If yes, please give details

Does your child have any diagnosis, or being assessed for anything?

Is there anything about your child's learning, communication or needs that would help me support them online?

Part 5: Safety & Suitability

This section helps make sure that online sessions are safe and suitable fit. Answering yes does not automatically mean your child cannot take part, but it may mean a different type of support is needed first.

In the last 6 months, has your child talked about or shown signs of wanting to hurt themselves or end their life?

Has your child harmed themselves, or are you worried they might?

Has your child behaved in ways that put themselves or others at risk?

Is your child involved with Social Services/ Social care/ family care support?

Are there any current safeguarding concerns?

If yes, Please share further details

Part 6: Practicalities

Does your child have a quiet, private space and device for weekly online sessions?

Is your child aware of you applying, and how do they feel about it?

Part 7:

Which programme are you interested in?

The Family program includes 6 live Parent Circle sessions. Are you able to commit to attending these?

Which payment option would you prefer if you are offered a place?

Child Program $1,600 and Family program $2,000

How did you hear about The Child We See Program?

Part 8: Consent

I can confirm I am the parent or legal guardian of this child

I understand that completing this application does not guarantee a place.

I understand that sessions are online and not an emergency or crisis service

I consent to my information being stored and used to assess suitability for the program in line with the policy link.