PEERS® Social Groups - West Vancouver

 

Application Form:

e.g. 2014/03/12 for March 12, 2014
For example: mother, father, stepparent, grandparent, social worker, self-referral.
If other than English, what is your dominant language?
Preferred phone number(s); Identify home or mobile with H or M after the number.
Street Number, City, Province, Postal Code
Relationship, Language, Address, Phone; If different than first guardian.
Is there another email that you would like correspondence sent to as well (e.g., another parent)?
We are required to have consent from all legal guardians in order to provide services. If this is a concern, please let us know as soon as possible.
If sole guardianship has not been established then both parents are required to provide signed consent for services (eg. parents are separated or divorced). Please note that ABLE Clinic is not able to provide psychological services if guardianship is in active dispute and all parties do not consent to services.
Please put "N/A" or equivalent, if there is no relevant history for this item or the next.