2023 MJ Winter Groups
Please note all of our winter groups are being held at our MARLTON location. The cost of each group is $225.
Child's Name
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First Name
Last Name
Child's Birthday
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Month
-
Day
Year
Date
Parent/Guardian Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Can we send text messages to the phone number listed above?
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Yes
No
Email
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example@example.com
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What your primary reasons for enrolling your child in group?
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How does your child currently communicate?
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Full sentences
2-3 word phrases
One word verbalizations
Speech generating device (e.g. TouchChat, LAMP, Proloquo)
Sign Language
PECS
Other
Does your child receive private speech and language services?
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Yes
No
Name of facility where speech and language services are provided
Does your child receive ABA services?
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Yes
No
Name of facility where ABA services provided
Please check off any behaviors that your child demonstrates that should be taken into consideration when grouping your child with others:
Aggressive behavior (e.g. hitting, biting)
Self injurious behavior
Screaming/Yelling
Frequent tanrums
Eloping
Avoidance behaviors
Other
Does your child have any medical diagnoses?
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Yes
No
If so, what are the medical diagnoses?
Does your child have any food allergies or sensitivities?
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Yes
No
If so, please be specific in regard to allergies and/or sensitivities.
Is there any additional information that would be beneficial for us to know?
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MJ Winter Groups Payment
All of our groups are led by a licensed Speech & Language Pathologist. Please note that space is limited for each group session. Once the application is submitted, you will receive an email confirmation with further information. By December 15th, you will receive a text or email request make the full non-refundable payment for your 4 week group session. If unforeseen circumstances arise, we will address on a case by case basis.
Would you prefer to receive requests for payment via email or text message?
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Email
Text
By signing, you acknowledge that your payment is non-refundable and payment for groups must be made in full by December 15th in order to secure your child's spot.
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Preschool Enrichment Group- Ages 3 to 5
Our preschool group is designed enhance the communication, socialization, and emotional regulation skills of children aged 3-5 years. Through interactive and engaging activities, the group aims to promote positive peer interactions, build self-confidence, and improve verbal and nonverbal communication abilities. The cost is $225.
Preschool Enrichment Group
Tuesdays at 11:00AM Marlton Location 1/9, 1/16, 1/23, 1/30
Early Middle School Group- Ages 10-13
The Early Middle School Social Skills Group is designed for children aged 10-13, focusing on refining social interactions, communication abilities, and self-confidence. The group aims to help participants navigate the complexities of social relationships, develop effective communication strategies, and build strong self-esteem essential for adolescence. The cost is $225.
Early Middle School Group
Thursdays at 5:30PM Marlton Location 1/11, 1/18, 1/25, 2/1
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