Groups Summer 2026

Welcome to CORE Connection Counseling

Group Pre-Registration Form
Thank you for your interest in our groups!!

We offer social and emotional skills groups for kids, teens, and young adults.

When forming our social skills groups, we consider the social understanding, social skills and emotional functioning level (in addition to chronological age and grade level) to place children/teens/young adults in groups that are matched well and working at similar skill levels. An intake session is completed prior to finalzing placement in a group. Therapeutic groups can be submitted to insurance for reimbursement. We are in network with Blue Cross Blue Shield PPO, Blue Choice, Blue Cross HPN, and Aetna

Educational skills groups are self pay and not billable to insurance.

New groups are typically offered: Fall, Winter/Spring, and Summer.
Summer Groups 2026

Choose the group below:
Crafting Calm - Entering 2nd-4th gradeWild & Grounded: A Summer Nature Circle for Kids 6 yo- 8 yo (self pay group)
Junior High School Social TheatreMind & Body Reset
Music & Movies Teen Girls Group
Client Name*

FirstMiddleLast
Date of Birth:*
Gender*
Client Address:*

Street Address

Apartment/Unit Number

CityState

Postal / Zip Code
Grade Level for 2026/2027 school year:
Options: Elementary through High School only. If no option applies, select Other
Yes - new clientNo - current or past client
Diagnosis, health conditions, medications, allergies and/or special diets?
240 Character Max
Primary Contact Name:*
Primary Cellular Phone #:*

Area CodePhone Number
Primary Contact's Email *
example@example.com
EDUCATION INFORMATION School Name and District: (n/a if not in school)*
Does the client have an IEP or 504 Plan? *
General EducationResource RoomSelf Contained ClassroomHomeschoolTherapeutic SchoolNone ApplyOther
Current Services Received (select all that apply):
Please list classes or subjects client does best in academically:
Please list classes or subjects client academically struggles with most:
Please describe personal strengths, area(s) of interest, and extracurricular activities:*
Please provide your concerns regarding emotional, social, behavioral functioning at home, school, work and/or in the community:*
Briefly describe 3 social and/or emotional goals and/or how you hope this group will benefit the participant? *
1)
2)
3)
"Please note any special considerations or information that you think it would be helpful to know about your child i.e likes, dislikes, preferences.
Please tell us how you found out about our office or heard about our social/emotional groups:*
Name of Referral Source:
Questions or additional information to share?
Blue Cross Blue Shield PPO, Blue Choice, Blue Cross HPN-In NetworkAetnaOther Insurance submit claims as a courtesySelf-Pay
YesNo, thanks
Email
example@example.com
Should be Empty:

Summer Groups 2026