Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Photography Location

Greensboro, NC

Tampa, FL

Does your child have any medical conditions we should be aware of? (Check all that apply)

Oxygen Support

Feeding Tube

Sensory Sensitivities bright lights, loud sounds, certain textures)

Respiratory Issues (e.g., oxygen support)

Temperature Sensitivity

Hearing Impairment

Vision Impairment

Hypotonia (low muscle tone)

Seizures

Are there any mobility concerns? (e.g., uses a wheelchair, needs assistance sitting or standing)

Yes (Please explain)

No

How does your child communicate best?

Verbal speech

Sign language

Gestures/expressions

Communication device

Non verbal

Are there any triggers or behaviors we should be aware of to help keep your child happy and engaged?

Yes

No

Do you prefer:

Solo portraits

Photos with family/siblings

Both