Aurora Behavior Clinic Social Skills - Inquiry Form

We are now accepting students.

There may be 2 types of specialized social skills groups to best fit your child’s social needs. One group is a best fit for children who are conversational but require extra help and prompting to socialize, and a 2nd class facilitates basic social skills for students who need more intensive instruction to interact with peers. We are also developing a social skills class which will focus on more subtle issues such as bullying, personal space, perspective taking, etc. All classes will meet on Tuesdays from 5:30pm to 6:30pm. An interview with parents will help determine the best group for your child.

Please fill out the form and a staff member will contact you to get more information as needed. Once groups are formed, we will email you with all the needed details to participate!

Thank you!
-Kendra McDonald
Director of Clinical Services

(This survey is best viewed when using a Google Chrome browser)

Aurora Behavior Clinic Social Skills Groups
Your First & Last Name *
Your answer
Your Child's First & Last Name *
Your answer
Gender *
Your Child's Birthdate *
MM
/
DD
/
YYYY
Your mailing address: *
Your answer
Your Phone Number *
Your answer
Your Email Address *
Your answer
How did you hear about us? *
Has your child attended a social skills program in the past? *
Please describe your child's personality: *
Your answer
What are you hoping that your child will learn or gain from this program? *
Your answer
Is your child independent in the bathroom? (may not be a requirement) *
Your answer
What are your child's favorite reinforcing activities or items? *
Your answer
Does your child have food allergies? *
Does your child have problem behaviors with other children (ie: aggressive behavior or taking things)? *
Additional Supports (Does your child receive one or more of the following additional supports?) *
Any additional comments about your child
Your answer
THANK YOU!
Thank you for taking the time to complete our Social Skills Program Inquiry Form.

Thank you again in advance for your interest in this fun, afternoon group! We will contact you as soon as possible to confirm your child's registration.

-The Team at Aurora Behavior Clinic at The Arc of Loudoun.
703.777.1939 ext. 207

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