Term Group Program Waitlist

Group Programs

Standby/Waitlist request or suggestions for future programs.
Is your preferred day or time for Group Programs unavailable? Or perhaps the session you want is currently full?

Enter your information below and if we have a cancellation or a session at your preferred day/time we will be in contact.
Your child's name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

DayMonthYear
Date
Preferred Name (if applicable)
She/HerHe/HimThey/ThemOther
Your details*

First NameLast Name
Your email*
example@example.com
Your Phone number*
For those who are new to our programs we will give you a call before we start
Your relationship to the child*
2-3 years old4 year old Preschool or Prep (traditionally 4-5 years old)Grade 1 - Grade 2 (traditionally 6-7 years old)Grade 3 - Grade 4 (traditionally 8-10 years old)Grade 5 - 6 (traditionally 10-12 years old)Teen/AdultOther
YesHas been to Village Therapy for therapy in the past but isn't currently doing ongoing therapyIs not having ongoing therapy with Village Therapy, but has participated in a group in the past 6 monthsNo my child has never been to Village Therapy
My preferred group is full and I'd like to be placed on a standby list if a spot becomes availableI would love to come but the day or time I prefer isn't available at the moment.Other
Which fully booked session would you like to waitlisted for?*
What is your preferred day/time for a future group program if you can't make the ones we are currently offering?*
Do you have any feedback or ideas for groups in the future?
Optional Only
Should be Empty:

Group Programs