*1.Child's Name:(Required.)

*2.Birthdate(Required.)

*3.Current School(Required.)

*4.Current Grade(Required.)

*5.Middle School your child will attend(Required.)

*6.Parent/Guardian 1 Name (Primary contact):(Required.)

*7.Parent/Guardian 1 Contact Number:(Required.)

*8.Parent/Guardian 1 Email:(Required.)

9.Parent/Guardian 2 Name:

10.Parent/Guardian 2 Contact Number:

11.Parent/Guardian 2 Email:

*12.Home/Mailing Address(Required.)

*13.My child seems worried about starting middle school.(Required.)

Not at all

Sometimes

Often

Very often

*14.My child has difficulty adjusting to new routines or changes in daily routines.(Required.)

Not at all

Sometimes

Often

Very often

*15.My child seems overwhelmed by current or anticipated academic expectations.(Required.)

Not at all

Sometimes

Often

Very often

*16.My child struggles with organizational tasks or time management related to schoolwork.(Required.)

Not at all

Sometimes

Often

Very often

*17.My child has expressed concerns about friendships, rejection, or fitting in.(Required.)

Not at all

Sometimes

Often

Very often

*18.I believe my child would benefit from a group focused on the middle school transition.(Required.)

True

False

*19.My child is willing to receive support and interested in attending a skill-building group.(Required.)

True

False

*20.What times and days would be best for us to call you to collect additional enrollment information and answer any questions you may have?(Required.)