Social Skills Group Intake FormMy child is enrolled in...(Required)Please SelectTeen TimeThe ImagineersChild's Name(Required) First Last Parent/Guardian Name(Required) First Last Email(Required) Phone(Required)School InformationSchool DistrictSchool NameGradePlease SelectKindergartenFirst GradeSecond GradeThird GradeFourth GradeFifth GradeSixth GradeSeventh GradeIs your child receiving, or received special services or accommodations (IEP, 504) at school?Please SelectYesNoPlease upload an image or PDF of their accommodations.Max. file size: 256 MB.Medical InformationDoes your child have any allergies, medical conditions, or take medications?(Required)Please SelectYesNoPlease specify (allergies, conditions, and/or medications)(Required)Personal InformationWhat are your child's likes and dislikes?What are your child's preferences? (activities, foods, sensory)Parental ConcernsParental GoalsAreas for Child ImprovementAnything else we should know?NameThis field is for validation purposes and should be left unchanged.
