Online PEERS Social Skills Group

Parent's Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Name (You may include initial if you prefer not to share at this point)(Required)

First Last

Is your child between 13 and 18 years old?(Required)

Yes

Child's Birthday(Required)

Has your child been diagnosed with autism?(Required)

Yes - My child has been screened and diagnosed with autism.

No - My child has NOT been diagnosed with autism or undergone a diagnostic screening but needs social skills group

Other

Does your child meet the following prerequisites for the PEERS online group? Check the skills that your child currently exhibits.(Required)

Have the desire to acquire and maintain friendships

Have the availability to attend meetings on Thursday evenings from 6pm to 7:30pm

Have the dedication to practice newly learned skills outside of weekly meetings

Have the ability to have multiple conversation exchanges with peers

List Child's Strengths

List Child's Weaknesses

Does your child currently receive ABA services?

Yes

Which topics are you and your child most interested on working on during the PEERS group? (Choose as many as applicable)(Required)

Which package are you most interested in?(Required)

PEERS Social Group Sign-Up Form