AAC Social Group!
Welcome to Building Blocks Therapy's AAC social group; we're excited to have you join us! Our goal is to create a safe and comfortable environment for your child to have fun and meaningful interactions with peers using their communication devices.

Please use this form as a way to provide us with background information about your child and to register for our events. If you have any questions or concerns please email admin@buildingblockstherapy.com.

We look forward to seeing you soon!

Child's Name *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
What type of communication device does your child use? *
Your answer
What language system does your child use on his or her communication device? *
Your answer
What level of support does your child require to use his or her communication device? *
How long has your child been using his or her communication device?
Your answer
Does your child use any other modes of communication (e.g., speech, sign, gestures/pointing)? *
Please list any other modes of communication that your child uses *
Your answer
Guardian 1 *
Your answer
Guardian 1 Phone Number *
Your answer
Guardian 1 Email *
Your answer
Guardian 1 preferred method of communication *
Guardian 2
Your answer
Guardian 2 Phone Number
Your answer
Guardian 2 Email
Your answer
Guardian 2 preferred method of communication
Please indicate what session(s) you would like to attend *
Required
Additional information you would like us to know
Your answer
*Important Note
This group will be capped at 4 children. Each individual session is $30; payment for all 3 sessions in advance is $75. Once this registration form is received, you will be contacted regarding payment.

Please note: this is a social group, not a therapy session; therefore you will not see diagnostic codes on your paid receipt.
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