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Residential Schools in India Handicapped Schools in India Disability Schools India Special Schools India Special Schools India
NGO for Children with Cerebral Palsy, ADHD, Autistic, Aspergers, Mentally Retarted, MR, Down Syndrome

                         

MIRACLES HOME AND RESEARCH TRUST in association with ASTALAVISTA TECHNOLOGIES and MOTHER AND CHILD WELFARE AND RESEARCH FOUNDATION INDIA, is a NON-PROFIT secular organization, with RESIDENTIAL FACILITIES, Fully Equipped with the Pre school and School Session, providing Education and Training to all kinds of CHILDREN and ADULTS with Behavior Problems and Multiple Disabilities like Autism, Slow Learners, Aspergers, ADHD, Mental Retardation, Down Syndrome, Cerebral Palsy, Hearing, Speech and Visual Impairment, etc.


Name of Student:

  

Date of Birth:

  

IQ Level/Class:

  

Sex:

  

Languages Spoken:

  

Childhood History:

  

Immunization History:

 

Developmental Milestone:

 

General Behavior:

 

What keeps your child, calm and happy (please specify like gifts, chocolates, etc.):

  

Are there any particular times of the day when the problems / behavior is more likely to occur:

  

Does the problem occurs in the presence of particular person, if yes please provide details:

  

Was the child asked to do something or was the child refused something prior to the problem, if yes please specify:

  

How many times a day or how long does the problem occur with your child:

  

What do you or others generally do, immediately following the problem:

  

Which person in your house or outside the house are most affected by the problem:

  

How do you comfort your child at the time of the problem:

  

Please provide us with the medical history / disorders, etc. of the child:

  

Medication History (allopathic / homeopathic medicine in the past / current prescribed by a physician & name of physician/doctor):

  

Hobbies / Sports / Games / Likes and Dislikes, etc.:

  

Past time Behavior / Leisure Activities, etc.:

  

Problems in Speech / Physical Movements, etc.:

  

Nature, Name and Full Address of the School (Special / Integrated / Normal, Dates, Class till, etc.) :

  

School History & Date of Joining (if any) :

  

Attendance in School (details):

 

Interaction with People, Friends, Neighbors, Relatives at Social Gatherings, etc. (if any) :

  

Interaction with Strangers, etc. (if any) :

  

Major Emotional & Behavioral Problem:

 

Type of Family (joint/nuclear & number of persons):

 

What kind of Help/Support/Guidance are you looking for from us
(in brief, like want them to be independent, basic education via national open school, etc.):

 

Anything you would like to inform us about, (about his toilet training, does he get fits, about his fooding habits, other remarks etc):

 

Is your Child Toilet Trained?:

                    Yes      No

Have you heard about Treatment with NUMEROLOGY ?:

                    Yes      No

Interested to know how NUMEROLOGY can help your child ?:

                     Yes      No

How did you get to know us:

  

Fathers Name:

  

Mothers Name:

  

Full Residential/Postal Address:

 

City:

 

Pin:

 

Country:

 

Telephone (incl.country & city code):

 

Mobile (incl.country & city code):

 

Facsimile (incl.country & city code):

 

E-Mail:

 

 

OUR THERAPIES

Early Intervention | Special Education | Speech Therapy | Physiotherapy | Computer Therapy | Pet Therapy
Vocational Therapy | Occupational Therapy | Yoga & Meditation | Play & Recreation | What's New?

OUR SERVICES

The School | Rules & Regulations | Students Corner | Photo GalleryMother Teresa : A Tribute
Behaviour/Counseling Form | Admission FormAssociate with us | Commendations | Celebs Support

ABOUT US

About Us | Activities | Aim & Objectives | Future Plans | Sponsors | Product RangeSponsor A Child
Home | Team | Careers | FAQ's | Links | Disability Study | Location Plan | Contact | Query

24X7 HELPLINES

Airtel: +(91)-98310 78600, 98310 28888 Vodafone: +(91)-98300 28888, 98308 88888
Reliance: +(91)-93390 52222, 93300 28888 Idea: +(91)-90880 44880