Pre-Booking Information

Help us prepare for your group experience! Please share a few key details about your participant/caregiver so we can provide the best possible support from day one.

**Group Registration is 2 steps. Please ensure to complete both **

Step 1: Group Intake Form (fill out, click submit, form will refresh, scroll down, Thank You will pop up at the bottom line of the form)

Step 2: Group Booking Form (fill out, click Book Now to complete)

Step 1: Group Intake Form

First name of caregiver*

Last name of caregiver*

Address*

Phone*

Email*

Participant Name*

Participant Date of Birth*

Month

Day

Year

Participant age*

Emergency contact name*

Emergency contact phone*

Language/s spoken in the home *

How would you describe you child's communication patterns at this time?*

Sounds (eee, ahh, ooo)

Repetitions (baba, mama)

Gestures

Simple Signs

Single words

Phrases

Sentences

AAC device

Other

What do you hope for your child to benefit from with this communication group?*

Imitation skills

Vocabulary growth

Comprehension/understanding

Confidence

Socialization

Overall language skills

Other

Please describe any allergies or medical conditions we should know about:

Please describe any behavioral or sensory considerations we should be aware of:

Caregivers are expected to actively participate in sessions. Are you able to commit to this level of involvement?: *

Yes

Do you have any questions or concerns about your role within the group? *

Yes

Please confirm you have read and understand the following by checking the box:*

Groups require a min of 3/max of 10 participants

Enrollment fees are non‑refundable unless group does not meet minimum of 3 participants to run

Siblings not enrolled may not attend sessions

Please provide your signature to indicate you have filled out the information above accurately and understand all information provided:*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date*

Month

Day

Year

Step 2:

bottom of page