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Social Squad and Game Changers – Is this a good fit for my child?

Thank you for your interest in joining Hello Speech's Social Squad and/or Game Changer groups! Please complete this form to help us learn more about your child and identify if this is the right fit.

 Once we receive the form, our team will review your responses and contact you shortly to confirm next steps.  

If you have any questions, feel free to email us at info@hellospeechgta.com

Section 1: Basic Information

Parent name(s)

 *

Parent email

 *
Parent phone number *
Child's first name
 *
Child's last name *

Child's age

 *
Child's diagnosis (if applicable)
Section 2: Communication & Understanding
  How does your child communicate?   *
  e.g., full sentences, single words, gestures, AAC device, limited communication  
Can your child follow simple instructions (e.g., “Clean up,” “Come here”)?   *
Section 3: Social Interaction
How does your child typically interact with peers?   *
Required
Section 4: Support Needs
Does your child need support with any of the following?   *
Required
Section 5: Goals & Additional Notes  
What goals would you like your child to work on through the group?  
e.g., routines, communication, friendships, independence, coordination   
Is there anything else you’d like us to know to support your child?  
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