The Hullabaloo Social Skills Group Registration Question Title * 1. Child's Name: (First Name, Last Name) Question Title * 2. Date of Birth: (mm/dd/yyyy) Question Title * 3. Parent's Name: (First Name, Last Name) Question Title * 4. Contact Number: Question Title * 5. Email Address: Question Title * 6. Which group(s) are you interested in? Please select all that apply. Social Navigators Culinary Creations Club The Puzzle Collective Creative Expressions Question Title * 7. Goals you want your child to learn in a social setting. Question Title * 8. Does your child communicate their wants and needs effectively? Yes No Question Title * 9. Is your child interested in interacting with other children? Yes No Question Title * 10. Does your child engaged in challenging behaviour? Yes No If yes, (please specify) Submit Response