Social Skills Group Application
Please complete the following information. We will contact you within 48 hours to discuss your child's eligibility for a social group. We must ensure a "good fit" for all group members.
School and Grade for 2017-2018
Parent/Guardian email Address(es)
Parent/Guardian phone numbers
Where did you hear about our services?
Any dietary restrictions, allergies, or medical issues? Sensitivity to certain sounds, florescent lights, etc?
What led you to seek a social skills program for your child? (i.e. your own observations, recommendation from teacher, therapist, etc?) Does your child have any diagnoses, participate in a special education program at school, or receive any other special services (i.e. speech, OT, therapy, etc)?
Please describe your child's interests (favorite toys, TV shows, games, etc), favorite subjects, what he/she likes to do with free time at home and on the playground, as well as any extracurricular activities.
Please describe your child's current areas of need and any social skills deficits or challenges. What are your goals for your child in these areas? What would you like your child to be able to do as a result of participation in our social group?
Please describe any current or past behavioral challenges, if any (i.e. has difficulty staying with a group, has trouble following directions, displays verbal or physical aggression such as hitting, biting, or kicking, tries to injure self, etc.) If your child has a behavior plan at school, please email it to us.
Please provide the name, email, and phone number for at least one teacher or therapist who knows your child well and can speak to his/her strengths and needs.
If there is anything else we should know about your child, please share it here.
Thank you for your application to Social Skills for Life groups.
We will be in touch soon!
Please check the box below.
Do Not Fill This Out