Ready, Set, Play Group Application.pages

KidsLink Neurobehavioral Center
2132 Case Parkway North
Suite A
Twinsburg, OH 44087
330-963-8600
www.kidslinkohio.com
READY, SET, PLAY! - Summer 2012
Description: Ready, Set, Play! is:
• A Social Language and game group that focuses on building social skills and
pragmatic communication while encouraging:
o Teamwork
o Group games
o Collaboration with peers
o And most importantly FUN!
Who: Ready, Set, Play! is for:
• Any child ages 5-10 that needs support in the area of social, pragmatics and/or
motor skills.
When and Where:
• Saturdays at Kidslink Neurobehavioral Center and Hudson Springs Park (weather
permitting)
• 10:00am or 12:00pm group options (sessions are 1 hour)
Summer 2012 Dates:
Saturdays
July 28
August 4
August 11
August 18
August 25
Cost:
• $75 per session ($375 for all 5 sessions)
Led by:
• Dr. Jocelyn Geib, MA, CCC/SLP (Speech Pathologist)
• Lindsay Watson, PT, MPT (Physical Therapist)
Application and Enrollment Process:
• Please complete attached application and return with payment to Kidslink
Neurobehavioral Center: Attention Dr. Jocelyn Geib, 2132 Case Parkway North,
Twinsburg, OH 44087
• Parents are encouraged to apply as early as possible, as enrollment is limited. Call
Kidslink at 330-963-8600 with any questions.
We look forward to working with you and your child!
Ready, Set, Play! Group Application
CHILD INFORMATION:
Name: ______________________________________________ DOB: __________________Age__________
Parent/Guardian: ________________________________________________
Phone: _____________________
Address: __________________________________________________________________________________
Been in group previously?
Yes______
No______
If No, do you currently see other providers at KidsLink?
If Yes, Last Session? _____________________
Yes_____
No_____
My primary concerns and areas of need in regards to my child’s
language and social skills:
Any other important information:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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