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

Registration is NOW OPEN for social skills classes, small group instruction, parent coaching, and ABA sessions. What are you waiting for?

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)

Welcome to our community!

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

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