Root & Gather Registration Form (2026)
Welcome!!

* Please note this registration form can be completed in any way that best suits you. If you would prefer to voice to text the answers, email a voice memo or complete the document in a different font (opendyslexic) please let me know at allison@risepediatrics.com so accommodations can be made.    

Group information
This is a continuously evolving neurodivergent-affirming social emotional learning group. Meaning we will encourage all individuals to be themselves and meet their unique needs while learning how they can socially engage with peers when choosing to.  We will focus on learning about all the ways peoples bodies move, think, function and engage. We will teach the kids to be curious when engaging with a peer who might present differently then themselves. Kids will be taught kindness over everything to themselves and others. We will teach what you might see from someone who is ready to socially engage with you, what you could do if you aren't sure and how can fix a mistake that's happened.

This group is suitable for children aged 5-10ish.  If your child is outside this age window but you think it would be the right fit developmentally. Please register and email us to further chat about it. ​

Sessions will be located in the Bragg Creek , just a short 2 minute, 1.5 km from the town centre. 

The total cost of the semester is $775. This fee is non-refundable.

For those with FSCD funding, the reimbursement amount is $700, and the family contribution is $75.  

Enrollment Process: After completing this registration form, within 48 hours you will receive an email with the intake form with the consent and liability outlined, and the invoice for payment.
(Please note, your child's spot in the group is not confirmed until intake is completed, consent and liability forms are signed and payment received in full.)

Additional information:
​Structure: Each group will be led by Allison (OT) and be supported by 1-3 students volunteers. You can expect a minimum adult to child ratio of one adult to four students. There is a minimum requirement of 6 children per group. The goal of the group is for kids to naturally socially engage with peers so during play times adults will try to stay back, gently support kids with peers and fully step in when needed.
Parent Participation: This group is a drop-off group however parents are encouraged to attend the last 15 minutes of each session to hear the wrap up of the topics discussed that day. ​​​​​​​​
Skill Development: While focused on social skills, the program's structure also supports fine motor skills, gross motor skills, sensory regulation, emotional regulation, communicating effectively and play skills—all common areas of need.
Self-care: Children must also be able to use the washroom independently or have a parent who is willing to stay close to ensure the comfort of your child should they have a bowel movement. It is encouraged that children use the washroom upon arrival however student volunteers will be available to walk with children the short distance from our play area to the outhouses.
Expectations: Since this group is an outdoor group, children who register in the group must be able to follow the instruction to stay in the designated area to keep everyone safe. The group will mostly happen in the fenced in area on the back on my property however the group may go deeper into the forest near the creek for certain activities. 
Siblings: If you are registering multiple children in your family, please fill out a separate form for each child.
Accommodations: Please let us know of any accommodations that can be made to increase your child's feeling of safety, connection and engagement. Prior to the group sessions, an email will be sent out with pictures of the location so your child can get an idea of what to expect.
Screens: All screens should stay at home unless they are an AAC device.
Waitlist: If the class is full, you will be placed on a waitlist and notified if a spot becomes available. If enough families are interested, we may consider opening an additional classes.
If you have any questions, concerns, or curiosities please email info@risepediatrics.com

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Email *
Parent Full Name
Email Address
Phone Number *
Child Full Name
Child Date of Birth
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DD
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Which group would you like to register in? You can register in multiple semesters ahead of time. *
Required
Are you a returning family to Root to Rise Pediatrics? *
Do you have FSCD funding for this social skills group? (Since goals will need to be created and submitted to your coordinator) *
What is your FSCD File number?
Does Root to Rise Pediatrics have your permission to take your child's photo and share on the website, flyers or social media to promote various groups? *
Do you give consent for your child to be photographed to be shared privately only with the members of your group via google drive?

These pictures will ONLY be shared via google drive to the group for parents to see the kids hard work (play!)
*
Please confirm you understand this group encourages parent participation by attending the last 15 minutes of each session.  *
Please confirm you will stay in cellular range for the duration of the group session *
Please confirm you understand that your child's spot in the group is not confirmed until payment is received and consent/liability waivers signed .  *
Please confirm whether your child is able to use a portable outhouse. If your child needs support, we can create a protocol incase your child has a bowel movement.  *
Please confirm you understand that you will receive another intake form requesting information about child. The more details given in this form the more personalized sessions can be made to their unique interests, skills and goals. Please take your time to thoughtfully complete.  *
Any additional information you would like to share?
How did you find this group? *
A copy of your responses will be emailed to the address you provided.
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