Video Rental
The Interdisciplinary Council on Developmental and Learning Disorders (ICDL) has published a videotape series on Floor Time Techniques and the DIR (Developmental, Individual-Difference, Relationship-Based) Model.  The Hope For All Foundation has purchased these videos and together with Pediatric Interactions has made them available to families and professionals.  Based on availability, these videos and accompanying questions to guide observations may be rented for one month at no cost.  However, a rental request/agreement must be completed and a $50 deposit per video must be obtained at the time of checkout.  Once the rented material is returned in
it’s original condition, the check will be returned to the sender.  The videotapes will be located in Grayslake, Illinois.  If shipping is required an additional $7 per video must be provided to cover the cost of priority shipping.  Rental requests/agreements may be found at www.HopeForAllFoundation.org or by contacting Sarah Kozak at 847-223-7433, fax 847-223-7435 or email kozak@PediatricInteractions.com.  


RENTAL REQUEST/AGREEMENT

Please print form and fax to 847-223-7435.  All information must be completed.  If shipping is required,
available materials will be sent priority mail within 3-5 business days once payment for shipping has been
received and must be returned in original condition within one month to avoid charges.     


Requested Materials (may request up to two video tapes or one video set):

? Introduction to DIR
? Case 1:  Alex, Age 3
? Case 2:  Cole, Age 4.6
? Case 3:  Willie, Age 4
? Case 4:  Grace, Age 5.3
? Case 5:  Danny, Age 5
? Case 6:  Spencer, Age 5
? Case 7:  Curt, Age 3
? Case 8:  Gary, Age 22 months
? Case 9:  Grayson, Age 4
? Case 10:  Alex, Age 2
? Case 11:  Spencer, Age 6
? Case 12:  Caroline, Age 5

VIDEO SETS:
? 1:  The Basics: Relating & Communicating
           Introduction to DIR, Gary, Alex(2), Caroline, Grayson
   Shows families how to interact with their child to
support development  

? 2:  Sensory Regulation & Social Interaction
           Introduction to DIR, Danny, Alex (3), Cole
Shows families how to help a child overcome challenges of sensory regulation that interfere with the
ability to relate & communicate, enabling them to reach higher developmental levels

? 3:  Symbolic & Logical Thinking
   Introduction to DIR, Spencer (5), Curt, Spencer (6), Grace
   Shows families how to use pretend play to help their
child create & connect ideas, & to think logically


I authorize The Hope For All Foundation to charge the above credit card or cash the enclosed check for
the amount of: _______  ($50 per requested video) if any damage occurs to the materials or they are
not returned within one month of the rental request date.  I have enclosed $7 per video tape to cover the
cost of priority shipping unless obtained from Pediatric Interactions in Grayslake, Illinois.    
                                           
Signature_____________________________________

Materials should be returned to:  Pediatric Interactions Inc.
                                                    15 Commerce Dr., Suite 116
                                       Grayslake, IL  60030

Questions or requests for rental extension may be directed to Sarah Kozak 847-223-7433, fax 847-223-
7435 or email Skozak@PediatricInteractions.com.  Additional copies of the videos or DVDs may be
purchased at online at www.floortime.org.  

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