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?
What is your child's date of birth?
What grade is your child in?
2-3 years old; not yet in preschool
My Child: (check all that apply)
Has trouble holding conversations
Has difficulty with perspective taking
Wants to play with others, but sometimes doesn't know how or acts inappropriately
Currently receives ABA services primarily for social skills and flexibility
Did receive ABA services, but was discharged
Is mainstreamed for most of school day with some support
Has little or no social interaction/friends outside of school
Currently recieves ABA services mainly for behavior reduction, communication, and life skills
Participates in a self-contained classroom environment for most of school day
Would be a great model for others in play, conversations, and social skills
Wants to help guide and develop friendships with peers who may need support in making friends
Check the social skills class(es) you are interested in registering for
2 yr old-Pre-K Thur 930-1100a
K-5th grade (you will receive an email following this registration with session options)
Parent/guardian first and last name
Parent/guardian email address
Parent/guardian phone number
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
Emergency contact relationship to child
Emergency contact phone number
How did you hear about Social Skills Group?
Word of mouth
Any additional information you would like to add
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