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.
* Required
Email address
*
Your email
Child's Name
*
Your answer
Grade for 2020-2021
*
Choose
Preschool
Transition K
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Other
Name of School
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Parents Names
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
Please tell us how you heard of CCL/social thinking.
Your answer
My child attends
private speech language therapy
private occupational therapy
private physical therapy
Social groups
Other:
My child has a
IEP
504
Behavior Plan
Clear selection
How do you feel a Be Social Kids group can help your child?
Your answer
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
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:
*
Social Adventurers ( Preschool-K)
Mad Scientists (Pre-K -Grade 1)
Storytime (Preschool-K)
Think It, Move It (Preschool-K)
Take 1, Take 2 (Elementary)
Around the World (Elementary)
Social Smarts (Elementary K/1)
The Detective Agency (Elementary Grades 2-3)
Superhero Training Academy (Elementary Grades 3-6 )
In the Moment ( Elementary )
YouTube Decoders (Elementary)
Awesomely Social (Upper Elementary/Middle)
Train The Brain (Upper Elementary)
Teen Hangout (Middle/High School)
PEERS (Middle/high School)
Parent Coaching
Hanen Group
Other:
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of CCL.
Report Abuse
Forms
