3rd and Forth Grade Social Connection Group Registration From

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Greetings!

We are excited to have your interest in having your child attend this group.

Once you complete this form we will be in touch with you with the details of the group.
The group dates are November 17, 2020, December 1, 8, 15.22,29,2020 The Time is 3:00-4:00pm Via Zoom

Best
Mackenna Price and Lakhshmi Nagireddy,Social Work Interns, Next Place Therapy Services
office number 301-531-4227 w sabrastarnes.com

Your child's first and last name? *

What grade is your child in? *

Your First and Last Name, and Relation to the youth *

Phone number and email address *

Will your child be able to attend all of the groups?

Yes

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Name of your secondary parent/caregiver (first and last name)? Optional

Phone number and email of secondary parent/caregiver? Optional

What school does your child attend? *

How do you feel your child benefit from the group? Please give a brief description below. *

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