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Social Skills Inquiry Form
Please fill out the information below if you are interested in our Social Skills Program, and we will reach out to you shortly to provide more detailed information.
Please indicate your interest in the RCS Social Skills Program:
*
Seeking general information about the Social Skills Program
Interested in registering for the next session
Parent Information
Parent First Name
*
Parent Last Name
*
Email
*
Phone
*
Town / City
*
Splitter
Child Information
Please provide your child's name if you are interested in registering him/her for our next social skills session. If you are just seeking general information, child's name is not necessary.Please provide your child's birthday so that our team can determine the age eligibility for our Social Skills services.
Child First Name
Child Last Name
Child Date of Birth
*
Splitter
Insurance Provider
*
Is your child currently receiving services through RCS?
*
Yes
No
Is your child currently receiving ABA services from another provider (other than RCS)?
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Yes
No
How did you hear about the RCS Social Skills Program?
*
We are a current RCS family
Facebook
Google
Local SEPAC or school resources
Early Intervention center referral
Community/flyer
Other
Please let us know about any specific questions you have about our program:
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RCS Consulting
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