Name *

First Name

Last Name

Phone *

(###)

###

####

Project Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do your children struggle with any of the following? *

sleep

food

transitions

socializing

separation

communicating

siblings

friendships

sensory sensitivities

developmental delays

issues at school

not applicable

How big is the project space? *

350 square feet or less

351-899 square feet

900 square feet or more

What room of the house will you be designating as a play space? *

Select all that apply.

formal dining room

formal living room

children's bedroom

basement

attic

den

family room

office

garage

other

Does your project require construction/custom building? *

Yes

No

I'm not sure

Do you need help with any of the following? *

wallpaper selection

paint selection

flooring

window treatments

lighting

furniture

other

When would you like this project completed? *

MM

DD

YYYY

What would you like to see included in the space? *

pretend play area

library

crafting area

sports

trucks/trains/cars

sensory area (swings, sensory table)

gross motor activities (climbing, jumping, etc)

What are you interested in purchasing for your space? *

Select all that apply.

table + chairs

art table

art easel

storage bins

shelving

sensory table

bean bag seats

flooring

climbing wall

swings

play kitchen

other