Connect With Peers® for Teens "*" indicates required fields PARTICIPANT INFORMATIONName* First Last Date of Birth* Gender* Preferred Pronouns* Diagnosis* CIty* Does the participant exhibit any challenging behaviours that may prevent them from being in a group or participating in activities? (e.g., refusing to partake in role-play group activities, engaging with other activities or distractors at the same time, interrupting the instructor frequently)* Yes No Does the participant require 1:1 support within a group setting?* Yes No Does the participant communicate verbally?* Yes No Will the adult be available to attend all sessions?* Yes No SOCIAL COACH INFORMATIONName* First Last Relationship to Participant* Phone*Email* Will the social coach be available to attend all sessions?* Yes No CONTACT PERSON INFORMATIONSame information as above Yes Name First Last Relationship to participant Phone NumberEmail Please indicate all the times the participant and social coach will be available and together for a 30 to 45 minute phone interview with a facilitator. Our office will confirm your appointment time via email shortly.Monday Morning (9am-12pm) Early Afternoon (12pm - 3pm) Late Afternoon (3pm - 6pm) Tuesday Morning (9am-12pm) Early Afternoon (12pm - 3pm) Late Afternoon (3pm - 6pm) Wednesday Morning (9am-12pm) Early Afternoon (12pm - 3pm) Late Afternoon (3pm - 6pm) Thursday Morning (9am-12pm) Early Afternoon (12pm - 3pm) Late Afternoon (3pm - 6pm) Friday Morning (9am-12pm) Early Afternoon (12pm - 3pm) Late Afternoon (3pm - 6pm)
Phone: (778) 945-1435 Toll Free: 1 (855) 437-7095
Email: laurel@posAbilities.ca
Phone: (778) 945-1435 Toll Free: 1 (855) 437-7095 Email: laurel@posAbilities.ca