Inquire about Social Skills Classes

Child's First Name

Child's Last Name

Child's Birthday

Month

Day

Year

Child's Current Grade Level

Parent Last Name

Parent Email

Parent Phone Number

Please briefly describe why you are seeking social skills classes for your child

What specific concerns or behaviors have you noticed?

How long have these concerns been present?

Has your child previously been in a social skills class?

Yes

No

If yes, please explain

Does your child have a formal diagnosis (e.g., ADHD, Autism Spectrum Disorder, Anxiety, Dyslexia, etc.)?

No

Yes, Please List

Who diagnosed these conditions?

Anything else we should know about your child?

I consent for my child to attend social skills classes through The Kid Connection.

I confirm that the information provided is accurate to the best of my knowledge.

Parent/Guardian Signature

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