Art Together Questionnaire, Ages 10+

Art Together group is for ages 10+ to practice creating healthy friendships while engaging with arts and crafts. It will be a creative expression group with a focus on building strong, supportive friendships.

Our goal is to provide a safe and supportive space for participants to express themselves creatively and build meaningful connections with others who share their interests. Through engaging in a variety of art projects and activities, participants can explore different forms of creativity and personal expression. This group will be facilitated by Sarah Block, LMFT and Orion Zick, LMFTA. Parents will have the option to schedule parent-only follow up sessions with the group facilitators after week 4 and 8 of the group. You may select this option when signing the informed consent.

This is not considered a healthcare service, and is therefore NOT billable to insurance.

To apply, please fill out the form below. We will review your form to ensure your child will be a good fit for the group. Once approved we will send you a welcome letter, consent form to sign, and an invoice to finalize your registration. THIS FORM DOES NOT FINALIZE YOUR REGISTRATION!

Child's Name*

First NameLast Name

Caregiver Name*

First NameLast Name

Relationship to Child*

Caregiver Contact Email*

example@example.com

Child' Email (if applicable)

Caregiver Phone Number

Please enter a valid phone number.

Child's Date of Birth*

Date

What grade is your child in?

Which school does your child attend?

What pronouns does your child use?

What special interests does your child have?

Do you have any social, emotional or behavioral concerns for your child? If so, what are they? (Example: "my child sometimes struggles to communicate when they are frustrated")

Why are you seeking group support for your child?

What are you hoping your child gains from being involved in this group experience?

How did you hear about this group?

Other

The group meets on Thursdays from 6-6:50pm in person at our SPT offices on the following days (skip Oct 31st and Nov 28th):

October 3rd
October 10th
October 17th
October 24th
November 7th
November 14th
November 21st
December 5th

Applicable for Round 1 & 2: The group is prepaid for $585, excluding the parent meetings. Each additional parent meeting will be $85. If you are ill or not able to attend one of the groups, unfortunately, we will not be able to provide any refund.

Is there anything else you would like us to know?

Thank you filling out the screening form. Once you submit the form, we will review your form to ensure your child will be a good fit for the group. Once approved we will send you a welcome letter, consent form to sign, and an invoice to finalize your registration.

THIS FORM DOES NOT FINALIZE YOUR REGISTRATION!

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