Holiday Social Skills Program Expression of Interest

School Holiday Social Skills Intensive Program
Principal Speech Pathologists

Beverley Sher & Elizabeth Zhornitsky

Head of Practice (Sydney)

Jessica Singer

Melbourne & Sydney July 2023

Expression of Interest Form
Once we receive this form, we will email you a link to complete a more detailed registration form.

The second form must be completed before we are able to offer you a place in our program.

Groups from Kinder age through to Adolescents

Program run for 2 hours each day: either
9:00am - 11:00am
11:30am - 1:30pm

Fee for full course: $600

You will also be added to our mailing list for future groups

Melbourne Dates
Tuesday July 4
Wednesday July 5
Thursday July 6
Venue: 645 Glen Huntly Road, Caulfield South VIC 3162

Sydney Dates
Monday July 10
Tuesday July 11
Wednesday July 12
Venue: Level 5, 203-233 New South Head Road, Edgecliff NSW 2027
Name of Participant *

First NameLast Name
Date of Birth*
Age in July 2023*
Gender and pronouns*
Melbourne or Sydney*
Participant's school or kinder, campus and year level in 2023:*
2023 Year Level please
Name of person completing this form, and relationship to participant*
Email address (we will send you a registration form to this address)*
Mobile Phone number*
How did you hear about the social skills group?:
Should be Empty:

School Holiday Social Skills Intensive Program