Social Group Interest Form

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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.

Email *

Child's Name *

Grade for 2022-2023 (upcoming school year) *

Name of School

Child's Date of Birth *

YYYY

Parent Name(s) *

Phone Number *

Address *

Please tell us how you heard of CCL/social thinking.

Please indicate your choice

I am interested in virtual groups only.

I am interested in in person groups only.

I am flexible and interested in in person or virtual groups.

Clear selection

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?

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: *

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

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