Friendship Club Enrollment Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is to submit a formal request to join Friendship Club, Tuesday's Child's social skills group for children ages 6-8! You will receive a confirmation of your enrollment within 3 business days.

Children with behavior issues often lack critical social skills and miss important social cues. Friendship Club for children ages 6 to 8 can help. Our child behavior experts guide kids through fun activities to help them explore emotions, friendships, and expected behaviors. This group incorporates aspects of multiple social emotional curriculums, including In Focus, SuperFlex, and The Zones of Regulation and activities focus on helping children interact appropriately with peers. Our goal is to teach your child to make a friend, keep a friend, and be a good friend to themselves.

Please contact our office at 773.573.6936 or admin@tuesdayschildchicago.org should you have any questions!
This group will cost $600 per child, due upfront at the time of enrollment.

Email *

What is your Child's full name? *

What is your Child's Date of Birth? *Please note - Friendship Club currently only serves children ages 6-8* *

YYYY

What is the parent/caregiver's full name? *

Preferred Contact Email (will be used for group communications, billing, etc) *

Preferred Phone Contact *

Current Address *

What is your child's school? *

Which group are you intending to participate in? *

I would like to be contacted for the next round!

What grade are they in this school year? *

Do they have any specialized services at in or outside of school? *

IEP

504

Speech

Occupational Therapy

Developmental Therapy

Individual Therapy

Social Work

Option 8

None

Other:

Required

Does your child have a diagnosis? *

What led you to reach out to Friendship Club? What goals are you hoping for your child to work towards? *

Has your child completed an intake or other Tuesday's Child program previously? *

Yes

If so, when did they participate and what programs have they engaged in thus far? (If you are a new client, simply reply "n/a") *

This program will be following all COVID19 protocols for the City of Chicago, and a formal protocol and waiver will need to be signed by all participating families. This will include your child wearing a mask for the duration of the group. Please acknowledge the following question to demonstrate your understanding. *

I understand Tuesday's Child till be abiding by all COVID19 protocols as deemed by the city, state, and Governor's office at all times. I understand my child will be expected to wear their mask at all times during their program.

Required

Friendship Club costs a total of $600 for the entire program. This will be invoiced to the email provided above and is due prior to the group's start. Please note that once paid, Friendship Club fees are non-refundable and non-transferable. Enrollment in Friendship Club is not considered finalized until all open invoices have been paid. *

I understand the payment policy outlined above and agree to pay all Friendship Club fees as invoiced

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Tuesday's Child. Report Abuse

Forms