First Buddies Application
Thank you in your interest in Infinity ABA Therapy & Autism Service's social skills program for early learners! Due to the Covid-19 pandemic, we are not running First Buddies sessions until further notice. If you would like to fill out the application at this time, we will contact you in the future when we begin the next term!
Child's Full Name
Child's Date of Birth
Parent's Phone Number
Does your child have diagnosis? If so, please include
No formal mode of communication
Alternative communication (PECs, Sign Language, Communication Device)
Requires 1:1 support always
Requires 1:1 support sometimes
Does not require 1:1 support
Requires minimal support
Not toilet trained
Aggression towards peers
Aggression towards adults
Elopement (leaving area without permission)
Tantrum ( screaming/flopping on the floor)
Loud vocal stereotopy
No problem behavior
If your child is currently in school, select placement type
Not in school for current term
In district self-contained
In district inclusion
In district other
In district general education
Out of district specialized school
Identify the top 3 skills you would like to address in this social group.
Child's interests include
Child's dislikes include
Parents are required to attend Parent's Circle (session for parents that runs simultaneously with First Buddies). Are you able to participate in these sessions?
Who will be attending the Parent's Circle?
Limit to 2 people. Include name and relationship (ex. Mother - myself, Caregiver - Luke Skywalker)
What do you hope to get out of the Parent's Circle?
Do you have any additional questions you would like us to address?
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of Infinity ABA Therapy & Autism Services LLC.