The Social Stage Inquiry Form

The Social Stage Registration Form

For children ages 10 - 13. We are reimagining the therapeutic model for nurturing social skills development in children. Through an engaging and interactive approach, kids effortlessly acquire essential communication and relationship skills, self-awareness, and emotional intelligence without realizing the depth of their learning experience. We engage in self-discovery, explore emotions, & role-play through life's challenging moments using drama techniques, games, & play-acting. Please complete the following form, and you will be notified by email when the next group begins.
Child's Name *

First NameLast Name
Age*
Birth Date

MonthDayYear
Gender
If registering more than one child, please add the other child's name, age, date of birth and gender here.
Parent's Name

First NameLast Name
Parent's E-mail*
example@example.com
Phone Number
Please select the time zone where you will be living in Fall 2024.
Country where your child will be joining us from.
Please share relevent diagnostic information that you feel would best help us in supporting your child's success within the group.
What skills would you like to see your child(ren) get from participating in this group?
If you feel that your child requires additional support to develop social skills and you would like this to be part of your treatment plan and will be seeking reimbursement from a medical or educational plan, please check the following:
Should be Empty:

The Social Stage Registration Form