Level Up! Life Skills Spring 2024 Group

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Level Up! Life Skills Spring 2024 Group - 7/8th Graders

Executive Functioning Group Registration Form

Email *

What is your child's name? *

What is your child's age? *

What is your child's date of birth? *

YYYY

What grade is your child in (2023/2024)? *

What school does your child attend? *

What is your best phone number where we can reach you? *

How did you hear about the Level Up! group? *

Has your child been diagnosed with a mental or behavioral health disorder (i.e. ADHD, Autism, Anxiety, ODD etc.)? *

Yes

If yes, please list their diagnosis/diagnoses

This group will run for 6 weeks on Thursdays 6-7:15, October 26 - December 7, 2023. There will be no group meeting on November 23 (Thanksgiving). The group is limited to 6 students. Cost is $495 for the entire session, which includes parent training sessions on helping your child grow their executive functioning skills. Payment is due in full to secure your child's spot. Please indicate how you will be paying: *

I will bring a check on the first day to 13121 Eastpoint Park Blvd Suite H Louisville, KY 40223

I will call the office to make a credit card payment over the phone (502) 807-9551

Parent(s) name and address: *

Send me a copy of my responses.

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