Social Skills Registration Form - Jackson Autism Center

Social Skills Class

Social skills classes will run Fall 2014. The registration fee must be paid in order to secure your child's place. Sessions must be paid before the first class. No refunds will be given for missed classes. This allows the cost to remain low and keep small teacher-to-client ratios. Groups will be 3-5 individuals. A $25 registration fee is due upon registration to secure the individual's space. Additional session days/times may be added if needed. First come, first serve for day and time preference if additional sessions are added. A minimum of 3 individuals are required for the class to make. Any individuals who have not attended intervention before at Jackson Autism Center must schedule a 15 minute session prior to the classes beginning to help determine the best placement for the individual. You will be contacted to set this up and it is included in the cost of the class. *Classes will run Sept. 15-19 through Nov. 17-21.

Parent/Guardian*
First Last
Individual's Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Age*
Diagnosis(es)
Strengths:*
Weaknesses:
Likes:*
Dislikes:*
Dietary restrictions or allergies:
Other Important Information Specific to Your Child:
Select shift and mark the items below your child can do:*
Registration Fee*
Price:
By registering, you are agreeing to pay for the registration fee ($25) now and the entire amount of the social skills class ($400) by the first day of classes. Classes meet weekly for 1 hour 10 times.
Class Choice*
- 5-7 years
- 8-10 years
- Middle School Age
- High School
*If there are enough requests for an adult class, one may be added.

Social Skills Class

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