We look forward to working with your child.
Summer Fun at Behavior Matters
Name of Child_______________________________ Age_______________
Social Group Sessions at the Eagle River Clinic
Ages 3-6
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🗹 9am-12pm
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🗹 12pm-3pm
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🗹 9am-3pm
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Ages 7-9
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🗹 8:30am-11:30am
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Ages 10+
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🗹 12:30pm-4pm
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My child will attend social groups on:
🗹 2 day (Tuesday & Thursday)
🗹 3 days (Monday, Wednesday, Friday)
🗹 5 day (Monday-Friday)
🗹 I would like services for My child in the community: _______________ (location)
🗹 I would like services for My child at home _____ days a week for _____ hour(s) session(s).
🗹 We have vacation(s) planned for _______________________________. (dates)
🗹 We are moving this summer. If you would like a referral to another agency, please let us know.
*Schedules are First Come First Serve
**We may have to request additional units through your insurance company, please return no later than April 13.
***Due to schedule changes, your child may work with a different technician. This is a great opportunity for generalization of skills.
****Every week is a different, fun theme. We will also walk to parks and other local community locations.
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