Holding Space Collaborative Summer Group Form

Holding Space Collaborative Summer Group Registration Form

Please complete this form to register you/your child for our spring and summer offerings. Please select Therapy Group, Caregiver & Child Group, and/or Nature Meet-ups.
Therapy Group ($500.00)

This group meets for 1 week at a time during the weeks of July 12th, July 19th or July 27th. Sessions will take place Monday-Thursday between 9:00-12:00pm at the Xavier University HUB. Participants will be grouped based on age and skills. The focus will consist on skill building in the areas of sensory processing, regulation, reflex integration, and executive functioning, etc. Therapy Groups require a $100.00 deposit to secure the spot at the end of registration. The remaining balance will be invoiced 30 days prior to the group start date. You will receive an email confirmation of registration.
Caregiver & Child Group ($400.00)

This group meets during the weeks of July 12th, July 19th AND July 27th. Groups meet twice a week for 1.5 hours/day at the Xavier University HUB. Group selections will be Monday/Wednesday or Tuesday/Thursday. The focus will consist on skill building in the areas of sensory processing, regulation, reflex integration, and executive functioning, etc. Caregivers and children will have breakout sessions for skill development and time together to practice skill generalization as a pair. Caregiver-Child Groups require a $100.00 deposit to secure the spot at the end of registration. The remaining balance will be invoiced 30 days prior to the group start date. You will receive an email confirmation of registration.
Nature Meet-Up ($10.00/date)

Nature meet-ups occur the second Saturday of the month, April-July, from 10:00-11:00am. Meet-ups give children and families the opportunity to gather in different outdoor spaces around the Cincinnati/Greater Cincinnati area to engage in nature-play and mindfulness activities with others. There will be one planned activity followed by free play. Meet-up locations will be announced the month before the event date. You will receive an email confirmation of registration.
Child Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary E-mail
example@example.com
Primary Phone Number
Format: (000) 000-0000.
Caregiver name(s)
Group selection
Medical diagnoses, Special considerations, Allergies, Additional information that would be helpful for appropriate placement

My Products

Summer Group Deposit

This is a nonrefundable deposit to secure your spot within the group of your choice. This allows us to schedule and plan therapeutic activities accordingly. The remaining balance will be invoiced 30 days prior to the start date.

$100.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

ACH Bank Transfer

Should be Empty:

Holding Space Collaborative Summer Group Registration Form

Therapy Group ($500.00)

Caregiver & Child Group ($400.00)

Nature Meet-Up ($10.00/date)

Payment Methods