Social Skills Group Application

Social Skills Group Application

For students interested in participating in Critical Core Group
The Social Skills Group will use a role playing game (RPG) called Critical Core. Developed in cooperation with Game to Grow, this RPG builds on the power of play to provide a safe environment where players can try new skills with minimal risk! Incorporating mood regulation, frustration tolerance, collaborative play, and many other techniques, with this evidence based intervention can help children and adults who struggle to grasp the nuances of social interaction. These groups will be suitable for participants cognitive ages 9 and up who have basic listening and verbalization skills.

Our first group will be running January 29th with a second group starting February 2nd. There will be 8, 90 minute sessions, with a total cost of $150.00 that will be due at least 2 weeks prior to the first session. There will only be 6 spaces available in each group, so signups are limited. In order to get the most out of your sessions, it's important all sessions are attended.
Student Information
Name

First NameLast Name
Grade
School Last Attended
Gender
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student has an IEP?

YesNo
Parent(s)/Guardian(s) Information
Emergency Information
Name*

First NameLast Name
Relationship*
Phone Number
Please let us know if this child have any allergies*
Have this child had any serious illnesses or operations that may prevent them from participating in a board game?

YesNo
If yes, please describe
Does this child require any specific accommodations to sit at a table for 1 to 1.5 hours?

YesNo
Do you want to indicate any related information?
Why do you think this person would be a good fit for this group?
Do you agree to the cost for all 8 sessions as 150.00 and acknowledge payment is required prior to joining the group? This fee is independent of number of sessions attended. To obtain the full benefit, please plan to attend all sessions.

YesNo
Date of Registration*

MonthDayYear
Date
Signature*

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Social Skills Group Application

Student Information

Parent(s)/Guardian(s) Information

Emergency Information