Social Thinking® 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 *

* 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

Phone

* 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.

Social Thinking® Application Form

Social Thinking Application for Existing Clients

ABLE Developmental Clinic Inc.

West Vancouver Clinic:

Surrey Clinic:

Richmond Clinic: