GBC ABA Connections Social Skills Group Registration Form
Please complete the following form. Once a guaranteed spot is confirmed available for your child, you will receive an email confirmation with a contract to sign after which payment for the session will be collected. Please complete one form per child.
What is your child's name? *
Your answer
What is your child's date of birth? *
MM
/
DD
/
YYYY
What grade is your child in? *
My Child: (check all that apply) *
Required
Check the social skills class(es) you are interested in registering for
Parent/guardian first and last name *
Your answer
Parent/guardian email address *
Your answer
Parent/guardian phone number *
Your answer
Emergency contact first and last name- please list someone other than the parent listed above. This is a person to contact if we cannot reach the parent listed as primary contact above *
Your answer
Emergency contact relationship to child *
Your answer
Emergency contact phone number *
Your answer
How did you hear about Social Skills Group? *
Any additional information you would like to add
Your answer
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