Executive Functioning Groups at Waypoint

您的瀏覽器尚未啟用 JavaScript，因此無法開啟檔案。請於啟用後重新載入頁面。

Please fill out this form in its entirety. Upon submission, Dr. Woods will contact you to conduct a screening interview to see if your adolescent is appropriate for the workshop. Thank you for your interest!

登入 Google 即可儲存進度。瞭解詳情

電子郵件 *

Participant First Name *

Participant Last Name *

Birthday: Month/Day/Year *

YYYY

Guardian Name *

Email *

Phone # *

Home address (include city and zip): *

Grade and School for 2022-2023 Academic Year *

Do you have any physical limitations that the instructor should know about? (Please specify below.) *

Yes

必填

Is participant able to attend group on Mondays at 5:30 in Annapolis? *

Yes

Maybe

其他：

What electronic devices does your child have regular access to (e.g., iPhone, Android phone, MacBook, Windows-based laptop, iPad, Android tablet, etc)? *

How did you hear about this program? *

I am aware that this is not treatment for any specific mental health disorder, but a skills training workshop *

Yes, I understand.

必填

Please briefly describe the participant, and what kind of help they would benefit from. *

將我的回應複本寄給我。

提交

清除表單

請勿利用 Google 表單送出密碼。

reCAPTCHA

隱私權條款

這份表單是在 Waypoint Wellness Center 中建立。檢舉濫用情形

表單