Summer Social Skills Group Sign up Form

Summer Social Skills Groups Sign Up

For ages 9-12
Guardian's Full Name*

First NameLast Name
E-mail*
example@example.com
Contact Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Child's Full Name*

First NameLast Name
Child's Date of Birth *

MonthDayYear
Date
If you prefer to sign up for a single group session, please select the week you will be attending below. *
Allergies / Medical concerns / Additional Information *
What are your goals? What would you like to see your child accomplish over those 6 weeks?*

Summer Social Skills Groups*

9-12 years Social Skills6-Week Payment ($25 off!)

$425.00 Quantity

(Age 9-12) One Group SessionSign up for one group session

$75.00 Quantity

EMA Payment $75Sign up for one group session (Please Submit Payment Through EMA)

$ Free Quantity

Total

$0.00

Summer Social Skills Groups Sign Up