RSVP 1 — Social Kiddos

Intake form for Social Music Group

Please fill in the form to be considered to be part of a social music group in Vancouver. Filling in an intake form does not guarantee a spot in the group. Social Kiddos will reach out to you if there is a suitable group for your child at this moment.

Name

First Name

Last Name

Child's name

First Name

Last Name

Date of Birth

YYYY

Siblings? Ages?

Phone

(###)

###

####

Music connection group (younger learners)

Young Adults group

Preferred time of session?

Tuesdays 2:00-3:00

Sundays 3:45-4:45

Sundays 5:00-6:00

Tuesdays anytime between 9:00-1:00

How does you child communicate?

Verbal, non verbal, sign language, communication device, gesturing

Allergies? Medication?

Client challenges/behaviours?

Likes?

Dislikes? Triggers?

Level of independence?

Any previous group experiences?

Payment options

Other comments