Speak, Learn, and Play

Email*

Child's Name*

Date of Birth*

Child's Age*

Parents' Names*

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Any allergies or special alerts?

What school does your child attend?*

What grade is your child currently in?*

What is your child's diagnosis (if known)?

What therapies does your child currently receive in and out of school?*

Please describe your child's communication skills (communicating wants/needs, following directions, etc.):*

Please describe your child's social skills (who do they like to play with, how to they manage groups, how do they manage frustration, etc.):*

Please describe your child's self-help skills (eating, using the bathroom, etc.)*

Please describe your child's fine motor skills (using their hands, putting things together, etc.)*

What is your child's board game experience (favorite games, handling winning/losing, attention span)?*

What are your goals for your child in this group?*

Thank you so much for your interest! We will get back to you as soon as possible.

Board Games Social Skills Application