Summer 2024 Group Registration Form

Thank you for your interest in our Summer 2024 groups. Registration is now open!

If you are interested in having you or your child participate in a group this upcoming summer, you will find a brief registration form below which will need to be completed. Once you complete this form, our office will reach out to you to discuss payment options. If you do not hear from us within 48 hours of your registration, please call our office at 203-250-0305 or email Lois to ensure your registration went through.

If you are a new client to the SLC, please keep in mind that you must go through the intake process for a social group. All intakes for groups are $150 and payment will be expected at the time of your session.

Thank you!

Summer 2024 Registration Form

Parent / Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone Number

(###)

###

####

Participant Name

First Name

Last Name

Age and Grade

Please indicate the age and grade of the participant.

Name of Group

Please indicate which group your participant would like to be a part of.

Group Fee

Please indicate total amount responsible for attending our sessions.

Notes

Please feel free to add any notes about the participants you feel we should be aware of.