Speak, Learn, and Play

Social Skills Application

Posted on: November 18th, 2017 by Joe Lowery No Comments

I am interested in:*
- Facilidated Playdates
- Social Skills Groups
Child's Name*
Date of Birth*
Parents' Names*
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Allergies/Special Alerts
Diagnosis
Current School*
Grade*
What services (if any) does your child currently receive in school?
How does your child engage in small groups?*
What does your child like to play with?*
How does your child manage frustration/anger?*
If you are applying for the facilitated playdates, please tell us about the friend that you will be bringing with you (i.e. name, age, how long your child and the other child have been friends, what they like to do together, any concerns/disagreements that have come up in the past):
Untitled*
Thank you so much for your interest! We will get back to you as soon as possible to set up a screening.