Link! SRS Sexual Health Education Series for Youth "*" indicates required fields Participant Name* First Last Date of Birth* Preferred pronouns* Form filled out by* Relationship to participant* Phone*Email* City* How does the participant communicate?* Verbally (half/full sentences) Partially verbally (1-3 words) AAC (Alternative Augmentative Communication) Sign/Gesture/Picture Communication Does participant need a support person present to support them during the sessions?* Yes No Does the participant have a device with a camera and microphone to sign onto for meetings?* Yes No Does the participant engage in any of the following that will disrupt learning of others in the group? Display challenging behaviours (e.g., aggressive outbursts, self-stimulatory behaviours) Continuously late for meetings/difficult with time management Engage in off topic behaviours/conversations during instruction Other Provide detailsIs the participant motivated to learn this information?* Yes No I don’t know Are there any relevant comments/questions/information participant would like to share?What is the participant wanting to learn the most from the LINK! SRS sessions?*Are you okay with the screening person calling you for a short 15 min phone call or video call?* Yes No
