Social Group Interest Form
Please complete this form. We will reach out to you once it is received. Upon receipt, those new to the center will be contacted to set up a virtual "Meet and Greet" appointment if we have a current opening.  This will allow us to learn about your child and determine which group is most appropriate.
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Email *
Child's Name *
Grade for 2024-2025 school year  *
Required
Name of School
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent Name(s) *
Phone Number *
Address *
Please tell us how you heard of CCL/social thinking.
Please indicate your  choice
Clear selection
My child attends
My child has a
Clear selection
How do you feel a Be Social Kids group can help your child?
Does your child demonstrate behaviors that may prevent them from being safe in a group setting of 4-6 children? If yes, please explain.  *
My Child IS available for on the following days/times. (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
1pm
2pm
3pm
3:15pm
3:30pm
3:45pm
4pm
4:15pm
4:30pm
4:45pm
5pm
5:15pm
5:30pm
5:45pm
6pm
We offer a variety of longer and shorter groups throughout the year. This is not an exhaustive list of the groups we offer. 

Please check off any groups you may be interested in for your child. 
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Required
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