Social Group Interest Form
Please take the time to fill out this form.  Upon receipt, those new to the center will be contacted to set up a "Meet and Greet" appointment.  This will allow us to learn about your child and determine which group is most appropriate.
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Email *
Child's Name *
Grade for 2022-2023 (upcoming school year) *
Name of School
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent Name(s) *
Phone Number *
Address *
Please tell us how you heard of CCL/social thinking.
Please indicate your  choice
Clear selection
My child attends
My child has a
Clear selection
How do you feel a Be Social Kids group can help your child?
My Child IS available for on the following days/times. (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
1pm
2pm
3pm
3:15pm
3:30pm
3:45pm
4pm
4:15pm
4:30pm
4:45pm
5pm
5:15pm
5:30pm
5:45pm
6pm
I am interested in the following group: *
Required
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