HAT Project - Parent Questionnaire

The following questionnaire is the first step for you to find out more about the HAT Project. Please complete the PDF form below and email it to harGIVES@hargrove-epc.com.

download / print - parent questionnaire

OR please complete the form below

Child's Name

First Name

Last Name

Child's Date of Birth

YYYY

Parent's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Tell Us About Your Child – does your child need help sitting; describe how you support your child; does your child need help using his hands; how does he move or get around etc.

Goals or what you expect from having this adapted powered vehicle?