Social Motion Class Interest Form

Class Interest Form

Thank you for your interest in our social skills classes. Please complete the following information. Your name will be placed on an interest list. As soon as we have new classes available, you will be notified. Once you are notified, you will be able to schedule an intake interview to determine if our program is a good fit for your child.
PLEASE READ: For our program to be a good fit, students should be academically and cognitively average to above average. We do frequently have students who are also labeled as gifted. We do not accept students who display aggressive behaviors towards peers or adults. Students should be able to converse in age appropriate sentences. We will work on conversation skills during class. (If a student is nonverbal, but is fluent with an AAC devise, the program may still be a good fit. If you're not sure, please call!)
Child's name*

First NameLast Name
Child's age:*
Child's grade:*
Child's age*
Child's current school grade*
Parent/Caregiver name*

First NameLast Name
Parent/Caregiver Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caregiver email*
example@example.com
Parent/Caregiver best contact number*
Please enter a valid phone number.
A $30 intake fee is charged when you schedule an intake. Will you need this fee waived?*

YesNo
Will you need scholarship support for your child to attend this program?*

YesNoI'm not sure at this time
Locations

Please indicate below your top two preferred locations:
1st Location Preference*
2nd Location Preference*
Should be Empty:

Class Interest Form

Locations