Registration Now Open - Kid Mechanix - Getting Social Starts Here!

Registration is OPEN for social skills classes, school readiness programs, small group instruction, parent coaching, and individualized ABA sessions.

Follow these 3 easy steps:

1. Contact our Program Director to determine program suitability.

2. Schedule a free intake assessment.

3. Fill out our secure online registration package (below) and read the Policies and Procedures (click here)

Child's First Name

Child's Last Name

Primary Phone Number

Secondary Phone Number

Primary Email

Other email address

Primary Address (include postal code)

Other Address (if applicable)

Mother's Name

Father's Name

Custodial Parent

Emergency Contact Name

Emergency Contact Phone Number

Child's Gender

Child's Date of Birth

Diagnosis (Leave blank if n/a)

Siblings (incl. first name + age) (leave blank if n/a)

Child's School

Child's Grade Level

EA Support?

Allergies (leave blank if n/a)

Food Sensitivities (leave blank if n/a)

Primary Doctor

Doctor's Phone Number

Doctor's Address

OHIP Number

Please list your goals here. Be as specific as possible.

Child's Likes

Child's Dislikes

Credit Card Number

Expiration Date

CVC

Comments

Please read and review the Policies and Procedures before submitting.
Click here to access the Policies and Procedures.