2025 Dig, Grow, Explore Gardening Club

2025 Dig, Grow, Explore Gardening Club

Please complete this form to register for Dig Grow Explore Gardening Club!
Name of Child*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Interested Group Date - Days may be subject to change based on space and therapists availability.*

May 30thJune 27thJuly 25th
My child currently receives the following services at We are Better Together, School or another location:*

Speech TherapyOccupational TherapyNot Currently Receiving Services
How does your child communicate?*

Non verbalGesturesSingle wordsShort phrasesSentencesEngages in conversationsOther
Diagnoses:*

No diagnosisAutism Spectrum DisorderADHDSpeech/Language DelayDown SyndromeCerebral PalsyCognitive Impairment/Developmental DelayOther
Challenges: Please check the following challenges that describe your child

AnxiousWithdrawnRigidImpulsiveVerbally aggressivePhysically aggressiveDistracted/distracting to othersOppositional
Our current adult to child ratio is approximately 1:4. Will your child need additional support?*

YesNo
I acknowledge that if my child needs additional support, that I will be able to provide it*

Yes
Is your child potty trained*

YesNo
What do you hope to gain from the gardening club?

Conversational skills (greetings, initiates, eye contact, engaging, staying on topic, interrupting)Making friendsPlay skills (turn taking, initiating, sustained play, following rules, sportsmanship)Practice using or increasing Speech/Language SkillsPractice using or increasing Occupational Therapy Skills (Fine motor, sensory, etc)Other
Other information you would like to share about your child that will help us best accommodate them during Gardening Club.
I acknowledge that this is not a free service. I understand that each gardening session will cost $60 and that payment is due at registration*

I acknowledge
Caregiver/Parent Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Best way to contact you*

EmailPhoneOther
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.
How did you find out about our gardening club? If it was from one of our staff please write in the staff members name.
Exciting things are coming your way! Keep an eye on your inbox for an email with all the details on what's next in your Gardening Club journey!
Gardening Club Registration Fee - There will be a $60 registration fee for each Gardening Club class your child attends. This is a nonrefundable fee. *

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2025 Dig, Grow, Explore Gardening Club

Exciting things are coming your way! Keep an eye on your inbox for an email with all the details on what's next in your Gardening Club journey!