Interest Form: Girls' Self Esteem and Social Skills Group
We aim to guide and support girls experiencing difficulties with peers at school and in other social interactions.

The group format allows girls to connect with others while learning tools. We will use a curriculum that addresses basics of friendship and conversation, managing emotions and conflict, as well as developing positive self image and empathy.

This group is in the preliminary planning stage so the age range, appropriateness of each child and focus of the curriculum will be assessed and adjusted as the group comes together.

Meetings will be 50 minutes in length and be held weekly for 4 weeks and a rate of $15 per session.
Email address *
What is the name of the child interested in enrolling in the group?
For enrollment of multiple children, please complete separate forms
Please list all legal guardians for this child and their relationship:
I.e. Mother, Laurie Jones; Father, Sam Jones
Phone number:
What Grade is Your Child in?
This group is currently available for girls in grades 2-5. For other age group inquiries, please complete a group request form at
Where does your child attend school?
What are you hoping for your child to gain from this group?
Does your child experience challenges in school or have a current diagnoses we should be aware of?
Are there any allergies, health, or safety concerns we should be aware of?
For all children under the age of 14, consent of all legal guardians is needed prior to group involvement. Are there any custody arrangements for your child?
When would you like this group to begin?
When would your child be available for this group?
Is there anything else you would like to share with us?
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