Customer Profile Page 3
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3What strategies/techniques are used at home/school/work to promote positive behavior
and/or discourage or redirect inappropriate behavior? You are welcome to provide a copy
of the plan.
Under the Americans with Disabilities Act (ADA) your child is entitled to reasonable
accommodations as a customer with a disability. What specific ADA accommodations are
you requesting? (Examples: written visual schedule, behavior plan, adaptation or
modification to instruction or equipment, lower staff ratio, etc.)
If enrolled in a summer camp, will the customer need medication dispensing, g-tube
feedings, or any other medical procedure during program hours?
Yes
No
Please return this form electronically to:
Gary.Logue@fairfaxcounty.gov
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