Executive Function Support Parent Intake Form

Parent Intake Form

Thank you for your interest in The Blue Marble Academy’s Executive Function Support Skills program!

Our individualized EF sessions are designed to help students in grades 2–12 develop essential learning skills — including organization, time management, focus, planning, and self-regulation.

Your instructor will work with your child to build strategies that strengthen independent learning habits, improve academic performance, and reduce school-related stress.

Please complete this form for each student you wish to register for coaching.

Parent Intake Form

Parent First Name

Parent Last name

Address

City

Province

Postal Code

Phone

Student Information

First name

Last name

Age

Individual Education Plan (IEP)

If your child has an Individual Education Plan (IEP) or any supporting documentation that helps us understand their learning profile, please upload it here.

Upload File

Upload supported file (Max 15MB)

Student Profile Template

In point form, insert brief but specific information about your child’s strengths and preferences.

In point form, insert brief but specific information about how your child communicates, in particular how he/she communicates that he/she is having difficulty.

Based on your experience, provide a list describing how your child learns best.

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(905) 833-3233

Executive Function Support Parent Intake Form

Parent Intake Form

Parent Intake Form

The Blue Marble Academy

We acknowledge that we work, learn and play on the traditional unceded territories of the Wendat, the Haudenosaunee, and the Anishinaabe nations We acknowledge that these are the treaty lands of the Mississaugas of the Credit