Social Skills Group Interest Form

Social Skills Group Interest Form
Child's Name*

First Name Last Name
Date of birth*

MonthDay Year
Date
Gender*
Age*
Parent/Guardian*

First Name Last Name
Phone Contact Number*

Area Code Phone Number
Email*
Please indicate which group(s) you are interested in joining below. Our programs director will then be in touch with you via email or phone within 1-2 business days regarding your interest. Thank you for choosing TLC! We are looking forward to working with you
Social Groups for Ages 2-3

If interested in this box check off and we will contact you
Social Groups for Ages 3-5 year olds

Mondays 5-6 pm at MetairieWednesdays 5-6 pm at MetairieThursdays 4:30-5:30 at Metairie
Social Groups for Ages 5-7 year olds

Wednesdays 5-6 pm at ElmwoodThursday 4-5 pm at Elmwood
Social Groups for Ages 7-10 year olds

Tuesdays 4:15 - 5:15pm at MetairieTuesdays 4:15 - 5:15pm at Elmwood
Social Groups for Ages 11-15 year olds

Thursdays 4:15-5:15 at Elmwood
How did you hear about Therapeutic Learning Center's Social Skills Groups?

WebsiteFlyerWord of mouthSchoolFacebook/Instagram
Please give our Programs Director 1-2 business days to contact you about your submission. Thank you!

Therapeutic Learning Center
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Please give our Programs Director 1-2 business days to contact you about your submission. Thank you!