SPD Treatment Directory
Community Resource Registration Form

Note to Community Resources:

The best way to register with the SPD Treatment Directory is via the KID Foundation web site, at www.SPDNetwork.org. If you do not have web access, you may mail or fax this form to: KID Foundation, 1901 West Littleton Blvd., Littleton, CO 80120. Fax: 303-322-5550.

Please complete the form with care as the information will appear in the directory exactly as you provide it. Provide as much information as you can about yourself and your facility. This will help parents and others who use the SPD Treatment Directory to find a service provider who is the "best fit" for their needs. If you are filling out this form by hand, please print clearly.

You will be responsible for updating your entry as needed. We will send you an email periodically to remind you to make any needed changes.

Thank you for registering with the SPD Treatment Directory!

(If you offer more than one location, please register each separately.)

"*" Denotes a required field

Business Name*

Type of Business*

Address*

City* State* ZIP*

Country

Phone* Fax

Email* Web Site http://

Contact Person*

Program(s) Offered (please describe)

Whom does your organization serve? (infants, toddlers, adolescents, families, only boys, only girls, etc.)

How would you categorize your organization?
(check all that apply)
Advocacy
Entertainment
Hair care/hygiene
Parks and Recreation
Camp
Direct Service
Cultural
Other (please specify)

Client Information

Age Range of Participants

Number of Children with SPD Seen Annually

Number of Adults with SPD Seen Annually

Typical Size of Waiting List (if any)

Number of Years Special Needs Children Have Been Included in Program

Number of Years Children or Adults With SPD Have Been Included in Program

Describe the facility’s philosophy of service provision.

Special Equipment Provided

Please list any specific alterations that make the physical environment of your facility more accessible to individuals with disabilities.

Please list any safety features that are in place.

Is the facility handicap accessible? Yes No

Keep in Touch

Check this box if you'd like to receive occasional news and updates from the KID Foundation.

DISCLAIMER: The KID Foundation provides this data for informational purposes only. This listing does not constitute an endorsement by the KID Foundation. There is no guarantee that the information above is correct, up-to-date, or complete. Do not rely upon or act on the basis of this information without seeking current information from the individual listed. Obtaining this information from this web site does not create or imply that a professional relationship exists between you and the KID Foundation, or the individual listed herein and the KID Foundation or any of its staff. Use of the KID Foundation SPD Treatment Directory is expressly conditioned on your acceptance of the terms of this Disclaimer.

Sensory Processing Disorder Resource Directory home page: www.SPDNetwork.org

Questions or comments about the SPD Treatment Directory? Please email our Development Director, or call the KID Foundation at 303-794-1182.

The Sensory Processing Disorder Network
www.SPDNetwork.org
The KID Foundation
5655 S. Yosemite Suite 305
Greenwood Village, CO 80111

SPD Treatment Directory Community Resource Registration Form

The Sensory Processing Disorder Network www.SPDNetwork.org The KID Foundation 5655 S. Yosemite Suite 305 Greenwood Village, CO 80111

SPD Treatment Directory
Community Resource Registration Form

The Sensory Processing Disorder Network
www.SPDNetwork.org
The KID Foundation
5655 S. Yosemite Suite 305
Greenwood Village, CO 80111