Little Thinkers Social Skills Play Club

Intake Form

Please correct the errors described below.

Little Thinkers Social Skills’ curriculum highlights the importance of teaching children how to communicate effectively, share, take turns, and respect others’ feelings. The goal is to help preschoolers develop empathy, kindness, and good listening skills, which are all key components of successful social interactions.

Questions with an asterisk are required, while ones without asterisks are optional.

Parent Name

Child Name

Email address

Child's Age

Child's Gender

Male Female

Is your child diagnosed?

Yes No

Does your child imitate you or other children?

Yes No

Can your child take turns in games and activities?

Yes No

Does your child respond to questions directed at them?

Yes No

Does your child understand and respond to verbal directions?

Yes No

Does your child engage in socially unexpected behaviors (i.e. impulsive behaviors, long-lasting meltdowns, physical aggression)?

Yes No

If yes, please explain.

Does your child have difficulty staying seated during group instructional time?

Yes No

How would you prefer to make payments? Total payment for Little Thinkers Social Skills Play Club is $450. Payment will be conducted on Stripe

$50, Weekly $450, One time payment

Any comments, questions, or concerns?

Consent Form

By checking the box below, the parent / guardian agrees to the following statement:

I agree and give consent for my child to participate in the Little Thinkers Social Skills Play Club Program operated by Vybrant Potentials LLC.

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