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. Classes will be held Wednesdays, 1-2pm beginning the week of July 13 through September 4.
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
*
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Area Code
Phone Number
Student Information
Full Name
*
First Name
Last Name
Age
*
Birthdate
*
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Month
-
Day
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
Comments or Questions:
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