Initial Information for Social Skills Groups
Before enrolling in a social skills group at Windward Synergy Center, it is very important to get to know your unique child to provide individualized support. Understanding strengths, interests, and values can determine specific goals to help your child grow. Additionally this information will be utilized to make the best recommendations of groups that match to current interests and needs. We will do our best to accommodate schedule needs and preferences but due to the variety of the children that come to groups some accommodations may be requested by our team.
A Windward Synergy Center team member will contact you within 48 hours of your completion of this form. If you have more immediate needs or questions please reach us at 808-489-3548 from 9-5 Monday-Friday or by sending an email to
This form was completed on:
Prefer not to say
Diagnosis (if any)
Allergies or other health concerns? Please list if so.
Noted allergies or health concerns
Parent best phone contact
Three words to describe my child are...
My child's favorite activities/topics are...
How may times per week would you like your child to attend group?
Other activities my child currently participates in:
Days my child is NOT available (can't come to a group-groups typically start at 230 or 415 Monday-Friday)
My child currently attends:
My child receives the following additional supports (if any)
The top three skills I would hope my child would gain in social skills groups would be...
It is important for my child to have friends who are... (characteristics)
When my child is near same-aged peers, s/he....
Keeps to themselves
Plays with peers at same level
Additional comments in regards to playing with peers
My child seems confident in his/her environment.
I am not sure
Not at all (e.g. refuses/avoids independent exploration)
Needs little encouagement (e.g. tends to stay near familiar adults but can preoccuply by self)
Neutral (e.g. does not seem interested in surroundings and mainly self-occupied)
Agree (e.g. needs a little support to indepdently explore)
Loves the spotlight (e.g. self-driven to engage with surroundings and interact with others)
Does not apply
Check any difficult areas for your child when interacting with others
Keeping eye contact
Managing/coping negative feelings
Responding to others
Making transitions/being more flexible
Take interest in what others are doing
Taking turn with shared material
Taking turn to listen and speak
Staying on topic
Following group instructions
Making wants and needs known
My child communicates by:
The current level of independence for my child is:
Requires 1:1 support
May need some 1:1 support for some activities/tasks
Does not require 1:1 in a small group
Some things my child really likes are:
Some things my child doesn't like are:
Please share any additional information or comments you would like to share about your son/daughter.
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