Social Skills Groups Waitlist
Sign up to join the waitlist for our social skills group sessions. We'll contact you as soon as a spot becomes available.
Participant's Full Name
*
First Name
Last Name
Participant's Age
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Social Skills Goals
What would you like your child to gain from participating in the group? (Tick all that apply)
Select all that apply
Making and maintaining friendships
Turn-taking and sharing
Conversation skills
Emotional regulation
Confidence and self-esteem
Managing conflict
Understanding social cues
Coping with anxiety in social settings
Other
Diagnoses / Additional Information
Has your child received any diagnoses?
Yes
No
If yes, please specify:
Does your child receive other supports? (e.g., Speech Pathology, OT, Psychology)
Any behavioural or sensory considerations we should be aware of?
Previous Group Experience
Has your child previously attended a social skills group?
Yes
No
If yes, please provide details:
Funding Information
Funding Type
NDIS
Private
Medicare
Other
If NDIS: Plan Type
Self-managed
Plan-managed
NDIA-managed
Plan Manager Name & Email (if applicable)
Availability
Please indicate preferred days/times
After school (3:30pm–5:30pm)
Weekday mornings
School holidays
Saturday sessions
Consent
By submitting this form, you consent to our service collecting and storing this information for waitlist management and group planning purposes. Completion of this form does not guarantee immediate placement in a group. You may withdraw from the waitlist at any time by contacting our administration team.
Parent/Guardian Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Please briefly describe your goals or reason for joining the social skills group.
Is there anything else we should know? (special needs, accommodations, or preferences)
Join Waitlist
Should be Empty: