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Social Groups – Application Forms for West Vancouver Groups

Social Groups - Application for New Clients (West Vancouver)

Child's Name *

First

Last

Grade? *

Date of Birth *

Age *

Parent's Name *

First

Last

Email *

Phone Number *

Sibling names and ages

Address *

Address line, City, Province, Postal code

School Name and District/City:

Date of Application

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.

Preferred Days - 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. *

Does your child have an IEP? *

If your child is enrolled in a Special Education class or specific service, please list those here: *

If your child receives Speech and Language services or has received them before, what is/was the frequency and duration?

A. If we were to observe your child at school, please describe what we would see during: Structured time (such as classroom learning)?

B. What would we see at school during: Unstructured time (such as recess/lunch):

C. If we were to observe your child at home, please describe what we would see during: Structured time (such as classroom learning)?

D. What would we see at home during: Unstructured time (such as recess/lunch):

Brief Letter to Jenny & Associates

Please write a brief letter describing your child. We know your child is unique. Please provide us with a letter outlining your child’s strengths and difficulties. For example, you could include info about some or all of the following skills: -Typical interactions with peers look like… - Friendships -Self-confidence -Language capabilities -Motivation to please others -Awareness of their difficulties -Organizational skills -Being part of large or small groups -Problem solving -Manipulation (by them, or by others) -Etc.

Comment

* 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 Groups - Application for Existing Clients (West Vancouver)

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

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

* 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.

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ABLE Developmental Clinic Inc.

We are here to help you! If you have any questions, please contact one of our three clinics in West Vancouver, Surrey and Richmond. Click the button below to get started.

Getting Started

West Vancouver Clinic:

#110 – 585-16th Street.
West Vancouver, BC V7V 3R8

Phone: 604.922 3450
Fax: 604.922 3454
Email: westvan@ableclinic.ca

Surrey Clinic:

#12 – 15243 – 91st Avenue
Surrey, BC V3R 9K2

Phone: 604.584.3450
Fax: 604.584.3457
Email: surrey@ableclinic.ca

Richmond Clinic:

Pacific Autism Family Network
3688 Cessna Drive
Richmond, BC V7B 1C7

Phone: 604.207.1984
Fax: 604.238.9222
Email: richmond@ableclinic.ca

COVID-19 Message (Updated on June 29, 2022): Click READ MORE to see updates regarding COVID-19

Social Groups – Application Forms for West Vancouver Groups

Social Groups - Application for New Clients (West Vancouver)

Social Groups - Application for Existing Clients (West Vancouver)

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ABLE Developmental Clinic Inc.

West Vancouver Clinic:

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