Registration

Arranging social skills groups requires a great deal of consideration. We try our best to meet everyone's needs. In order for this to be as successful as possible, please answer the questions below to the best of your ability.

Parent/Contact *

First

Last

Child Name *

First

Last

Email *

Phone Number *

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Age *

Where your child is currently attending school? *

Is your child verbal? *

Is able to express their wants, needs and preferences? *

Is able to identify emotions in themselves? *

Identifies emotions in others? *

Follows one step directions? *

Follows multiple step directions? *

Is your child aggressive towards peers? *

Is your child aggressive towards self? *

Does your child prefer to play by themselves or join in activities with others? *

Understands and uses humor? *

Follows the rules during games? *

Is accepting of comfort from others when upset? *

Is able to calm him or herself down when upset? *

Accepts losing a game without becoming overly upset *

My child understands that his or her behavior impacts peers: *

Accepts making mistakes without becoming overly upset or angry? *

My child has a sense of pride in their achievements: *

Please choose the time block that best fits your needs to attend group *

3:30 pm - 4:30 pm (M-F)) 4:00 pm - 5:00 pm (M-F) 5:00 pm - 6:00 pm (M-F) Saturday mornings

Use this space as needed to describe any additional information regarding the best days and times *

Submit