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Group Registration

Connect with us to begin your family's communication journey

Our care pathway begins with a simple, personal intake process designed to understand the unique needs of your family. We are here to support throughout this process.

Location

1395 Atwood Ave Ste 203A, Johnston, RI 02919

Call Us

401-232-4482

welcome@bluefeathercc.com

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

Play skills

Vocabulary growth

Comprehension/understanding

Confidence

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 8 participants for Curious Communicators & a min of 3/max of 6 participants for Courageous Communicators

Enrollment fees are non‑refundable

Siblings not enrolled may not attend sessions

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

Sensory Play Place Waiver is reviewed/signed

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

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Date*

Month

Day

Year

Email

welcome@bluefeathercc.com

Phone

401-232-4482

Office

Johnston, RI 02919

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