Lunch Bunch Social Skills Workshop Fall 2019

Link to Learn Behavior Therapy

9935 Eller Rd Fishers
www.linkedbehavior.com

317-863-8388

info@linkedbehavior.com

Participant Information

Child First Name *

Last Name *

Gender

Birth Date * +

Grade

Allergies / Dietary Restrictions: *

How did you hear about Link to Learn? *

What is most helpful to your child's learning? *

What activities or toys does your child like best? *

What skills do you want your child to gain during this group? *

Relationship to Participant: *

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Alternate Phone

Email Address *

Phone Number *

Would you prefer to be contacted by email or phone? *

Email

Phone

Emergency Contact Name *

Relationship to Child *

Workshop meets bi-weekly on Saturdays at Link to Learn

11:45am - 1:45pm

September 14 - December 21 2019

This is a drop off group, hopefully a 2 hour break for cargivers :)

Please bring a cold packed lunch for your child

We will send home enrichment activities to be completed at home (these are optional)

Monthly tuition = $100

Invoices must be paid prior to the start of group

Invoices will be sent via email on the last day of the month for the following month

(For example: an invoice will be generated on or before August 31 to reserve for the month of September)