March-April 2025 SEL Group -Registration Form
Be Well with SEL, LLC offers Social Emotional Learning (SEL) enrichment lessons to participants. Each class includes stories, discussions, games, videos, movement activities and/or crafts all relating to SEL skills. Skills and strategies taught are educationally based "enrichment programs" and are not individual treatment plans or a form of therapy for students.

Participants:
Participants must be able to follow Be Well with SEL's "Code of Conduct" that is written into the Client Agreement Form. A signed agreement form is required for each participant. 5 week classes are capped at 6 students, and must have 3 registered in order to run.

5 Week SEL groups offered include:
-SEL lessons aligned with at least one of the 5 core competencies of SEL (self awareness, self-management, social awareness, relationship skills, responsible decision making).
-“Take Home Note/Packet” after each class that includes skills taught and language used for carry over at home.

Payment:
The total cost of a 5 week SEL group session is $330/student. 
A 50% non-refundable deposit ($165) is due at the time of submitting this registration form. Please note that spots will be held for 3 business days only. If the deposit is not received by the 3rd business day, the spot will be released for another student to register. The remaining $165 tuition balance must be paid PRIOR to the start of the first day of class.
*If your registration needs to be cancelled, the deposit will be kept on file as a credit to use towards any future SEL group, camp, or workshop.

*Be Well with SEL, LLC also offers a $50 sibling discount if registering for a SEL class during the same session. A $50 discount is also offered if registering one child for two SEL groups during the same session.

Please note that Be Well with SEL, LLC does NOT accept insurance. Payment is accepted in the form of cash, check made payable to "Be Well with SEL, LLC", or Venmo @KristenPerrotti (last 4 digits are 6671 if Venmo requests it). If paying by check, please mail to:

Kristen Perrotti
Be Well with SEL, LLC
790 Turnpike Street, Suite 102
North Andover, MA 01845

AFTER SUBMITTING THE REFERRAL FORM, YOU WILL RECEIVE AN E-MAIL CONFIRMATION (within 24 hours) FROM KRISTEN STATING THAT YOUR CHILD IS REGISTERED FOR A SEL GROUP. IF YOU DO NOT RECEIVE CONFIRMATION AFTER 24 HOURS, PLEASE E-MAIL: kperrotti80@gmail.com
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Which group are you registering your child for? *
Participant Name *
Participant Age *
Participant Grade *
Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent/Guardian E-mail *
Emergency Contact Name AND Phone Number *
Please provide any additional information you feel might be helpful to know about the participant
Does the student receive any support services at school? *
If YES, please provide details
How did you hear about Be Well with SEL, LLC? *
"Code of Conduct" and SEL Group Client Agreement Form
 *
Required
*PAYMENT AGREEMENT:
50% of your child's group fee is due at the time of submitting this registration form. The remaining 50% is due on or before the 1st class.

Please note that spots will be held for 3 business days only. After the 3rd day, the spot will be released for another student to register.
 *
Required
Payment Method: *
AFTER SUBMITTING THE REFERRAL FORM, YOU WILL RECEIVE AN E-MAIL CONFIRMATION (PLEASE ALLOW 24 HOURS) FROM KRISTEN STATING THAT YOUR CHILD IS REGISTERED FOR A 5 WEEK GROUP. IF YOU DO NOT RECEIVE CONFIRMATION AFTER 24 HOURS, PLEASE E-MAIL: kperrotti80@gmail.com
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