Sense Kaleidoscopes - Secondary School Admission Form

Please fill out this form completely and accurately. All sections can be filled in by typing or by submitting voice or video responses. All fields marked with * are mandatory where indicated.

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REQUEST

STUDENT DETAILS

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DIAGNOSIS SUMMARY

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THERAPIES & SUPPORT HISTORY

Has your child received any of the following? (Check all that apply and describe)

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PARENTS DETAILS (IF PUPIL IS BEING BROUGHT IN BY PARENTS)


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GUARDIAN DETAILS

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MEDICAL + DIAGNOSTIC HISTORY

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SCHOOL & LEARNING HISTORY

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ARTISTIC INTERESTS & EXPOSURE

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BEHAVIOUR & REGULATION

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FAMILY CONTEXT & SUPPORT

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PROGRAM ALIGNMENT

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CONSENT FORM FOR ASSESSMENT (for admission purposes)

This consent form has to be submitted for the purpose of assessment by educators, developmental paediatricians and psychiatrists in order to consider the pupil for admission to the school. Please note that the assessment is chargeable and information on if/when the assessment is to be undertaken will be communicated to you.

PARENT/GUARDIAN DECLARATION FOR ADMISSION REQUEST AND ASSESSMENT

I,
, parent/legal guardian of
, aged
years, residing at
, hereby undertake, declare, and consent to the following on this day,
.
  1. 1) I understand that assessments must be conducted by Sense Kaleidoscopes (SK) to evaluate the suitability and eligibility of my child for admission into its educational programs.
  2. 2) I confirm that I have been informed of the purpose, scope, and nature of these assessments. I hereby give my informed consent for SK to conduct the necessary assessments. I agree to provide all relevant details requested in the admission and assessment forms, and I will furnish any additional documentation upon request.
  3. 3) I understand that submission of this application does not guarantee admission. Admission is subject to the outcome of assessments, fulfilment of all criteria, and is at the sole discretion of SK.
  4. 4) I acknowledge that initial assessments help determine if my child can be supported within SK's program framework. A complete understanding of my child may require up to three months of further observation and review after conditional admission.
  5. 5) I understand that SK reserves the right to deny or withdraw admission at any time if: information is falsified, misrepresented, or withheld; my child's needs exceed the scope of support that SK is able to offer safely and ethically; continued participation poses risk to the well-being of others in the program.
  6. 6) I consent to the sharing of assessment reports with internal professionals—doctors, therapists, teachers, staff, and consultants—who are directly involved in the education, therapeutic support, or capacity building of my child.
  7. 7) I also consent to anonymized data and insights from the assessments being shared with research institutions for educational, behavioral, or vocational research aimed at improving services for individuals with Autism Spectrum Disorder (ASD), provided my child's personal identity remains protected.
  8. 8) I understand that assessment reports and other documentation may be retained by SK in its secure data systems for the duration of the child's engagement with the organization and may be used to inform decisions on curriculum planning, safety protocols, therapeutic needs, and reporting to relevant authorities, if required by law. I acknowledge that SK will exercise reasonable care and professional diligence during the assessment process. However, I accept that I remain fully responsible for any reckless or harmful behavior by my child that causes physical injury to others or damage to property or equipment. I undertake to bear the cost of repair, replacement, or medical treatment if such a situation arises.
  9. 9) I confirm that I have fully disclosed all known behavioral, developmental, cognitive, and medical challenges to the best of my knowledge. I understand that failure to disclose relevant history may compromise SK's ability to support my child and may affect the continuation of services.
  10. 10) I understand that if my child is admitted, SK may continue conducting periodic assessments to review and adapt the child's support plan as needed. These assessments may include classroom observations, behavioral recordings, teacher evaluations, and professional consultations.
  11. 11) I acknowledge that all information collected will be handled in accordance with the Rights of Persons with Disabilities Act (2016), the Mental Healthcare Act (2017), and any applicable data protection laws. Information will be stored securely and shared only with authorized personnel under confidentiality protocols.
  12. 12) I am aware that I may be asked to participate in review meetings, progress evaluations, and capacity-building discussions related to my child's participation in the program. I undertake to cooperate fully in these processes.
  13. 13) I understand that I may submit required information in written form or through voice/video submissions, using secure formats (Google Drive, email, WhatsApp), or request a one-on-one appointment with SK's assessment team.
  14. 14) I take full responsibility for any reckless or unsafe behaviour by my child that may cause harm to themselves, others, or damage to property. I agree to bear the cost of repairs, replacements, or treatments necessitated by such actions.
  15. 15) I will comply with all policies and procedures during the assessment process, and I acknowledge SK's right to withdraw the assessment or admission at any point if guidelines are not followed.
  16. 16) I understand that providing inaccurate, falsified, or incomplete information may result in cancellation of the admission process at any stage.

Need help with your application?

Phone: +91 96061 85050
Email: [email protected], [email protected]