3- to 5-Year-Old Social Skills & Play Group Registration
Important:
After you submit a form for registration, we will send you an email confirming attendance. Acceptance into classes is based on open availability in the class. Confirmation emails will take about 24-48 hours after registration submission. Classes will be taken at our center at 811 Ridge Rd. Webster, NY 14580. Classes are open to all individuals.
Student Information
Guardian Information
Guardian Full Name (If same as participant's name please list participant's name)
*
First Name
Last Name
E-mail
*
Contact Number
*
-
Area Code
Phone Number
Student Information
Full Name
*
First Name
Last Name
Age
*
Birthdate
*
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Support From Adults
Please Select
Low Support
Medium Support
High Support
Support from adults needed to be successful in class setting.
Emergency Contact
Tell us a little about your child:
Comments or Questions:
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Photo/Video Consent
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