Social Groups Application Form

Child's Name *

First

Last

Grade *

Date of Birth *

Age

Parent's Name *

First

Last

Email *

Phone Number *

Address *

Address line, City, Province, Postal code

School Name and District/City:

Date of Application

Previous Group? (Please, indicate group leader and time)

Preferred Group Mates?

Preferred Location(s) *

West Vancouver
Richmond (PAFN)
Surrey

* Please note that your chances of gaining a placement directly relate to your availability! If your child is home-schooled, attends college, or has a flexible schedule, please note this as it will also increase your chances of obtaining individual treatment spots that would otherwise not be filled.

Select All Available Days/ Locations *

Mondays
Tuesdays
Wednesdays
Thursdays

* Please note increased flexibility will allow us more options to find the best fit for your child in terms of group.

Please note any time restrictions on the selected days/ locations. *

Additional Notes

Message

* Please note, we cannot guarantee the confidentiality of information transmitted through e-mail including the intake form. Please be aware of this limitation when contacting us.

A quick note about our new weekly social hangouts! Clubs will be a monitored, safe setting for kids and teens grade 6 and up to implement what they are learning in groups in a less structured setting.

This is an awesome way to generalize learned concepts and is available to Social Group clients only.

Club members will most often choose between videogames, crafts, and board games and can also switch between them. Occasionally- larger scale parties (Halloween Dance and Christmas Party) will make for special events and different set-ups. Staff ratios will remain high (1:7) and subtle cueing will be provided when required. Clinicians will use info from Clubs during weekly sessions when possible. Hangouts will be at the clinic after working hours- so we can be loud!

Runs mid September – mid December

Social Groups Application Form

Social Groups Application for Existing Clients

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ABLE Developmental Clinic Inc.

West Vancouver Clinic:

Surrey Clinic:

Richmond Clinic:

Social Groups Application Form

Social Groups Application for Existing Clients

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Like this:

ABLE Developmental Clinic Inc.

West Vancouver Clinic:

Surrey Clinic:

Richmond Clinic: