Registration for Peers Teens Program and Parents Training are included in this form.

Please correct the errors described below.

Your interest in the Peers Teens and Parents Training Programs are highly appreciated. This program is offered by Vybrant Potentials, a neurodivergent consultant agency, and will be solely conducted on zoom for 16 weeks. The Program for the Education and Enrichment of Relational Skills (PEERSĀ®), is an evidence-based social skill program facilitated towards individuals within the neurodivergent community.

For each grouping, we make compatible groups of participants ranging from 8 to 10. We are strategic in our lesson planning and group individuals with similar interests together.

Spaces are limited, so if interested please complete the following Intake Forms and you will be guaranteed a space in our Program(s).

Teen Section

To be completed by the teen enrolling in the Peers Teen Program

Social Coach Section (Parent's Training)

To be completed by the social coach. A teen's social coach should be someone who can support the teen through the Peers Teen Program, such as a parent, who helps to reinforce learned skills outside of the sessions. Each teen should have 1 coach who attends every PTP session.

Street Address
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1 is needs repeated prompting, 5 is responds independently.
1 is needs repeated prompting, 5 is follows directions independently.
1 is NOT interested, 5 is very interested

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