Please select the group you would like to register for:

Autism Assessment

ADHD Assessment

Social Connections Group - Clinic

Social Connections Group - Flag Football

Stuttering Group

Child’s First Name *

Child’s Last Name *

Child’s Date of Birth (DD / MM / YY)

Parent First and Last Name

Primary Phone (306-XXX-XXXX) *

Primary E-Mail *

Tell us about your child!? *

1 + 3 = ?Please prove that you are human by solving the equation *