Boxwave Kids: Initial Assessment Form Parent/Guardian Full Name * First Name Last Name Child's Full Name * First Name Last Name Child's Age * Email * Phone * (###) ### #### Section 2: Health & Lifestyle Child's Current Weight (kg) * Child's Height * Does your child have any medical conditions or injuries we should know about? * How many days a week does your child usually do physical activity? 0 1 2 3 4 5+ Section 3: Wellbeing & Confidence How confident does your child feel in themselves right now? (Scale 1-5) * 1 2 3 4 5 How happy does your child feel on most days? (Scale 1-5) * 1 2 3 4 5 How much energy does your child usually have during the day? (Scale 1–5) * 1 2 3 4 5 How motivated is your child to get healthier and fitter? (Scale 1–5) * 1 2 3 4 5 Disclaimer: * The information provided in this form will only be used by Boxwave to track your child’s progress throughout the programme. All data will be kept confidential and will not be shared outside of Boxwave without your permission. I confirm that I am the parent/guardian of the child named above, and I consent to Boxwave collecting and storing this information for the purpose of monitoring progress. Thank you!
