Fall 2023 Group Interest form

Fall 2023 Group Interest form

MM slash DD slash YYYY
Has your child received services at SRC or The Southfield Center previously?(Required)
Was your child in a previous group with SRC? Select the lead group facilitator:
Preferred location?(Required)
Select which of these activities are familiar to your child:(Required)
Please select all of the following 1-hour meeting times that would be feasible for your child starting the first week of October and extending through the first two weeks of December (will break for holidays). Each group will meet 8-10 sessions depending on the shared schedule of its facilitators and members. Please note: each group meets for 1 hour and sessions will be canceled if no more than 3 members are available.(Required)
If your child is new to our services, please email Christi (czacarola@sascoriver.com) with the subject line "New Group member registration." In the body of the email, include the following:
  • Child's full name
  • Date of Birth
  • Mailing address
  • Caregiver(s) full names
  • best phone number and email
This field is for validation purposes and should be left unchanged.