Sign Up For the Social Skills Group

This form starts the process of enrolling your child in the Social Group. All fields are required so that we can provide the best service for your child.

After filling out the form, you will reach a page that offers paying the full $225 upfront. You will need to pay the fee to fully enroll your child.

If you have any problems with the form or want to enroll multiple children, feel free to contact us at admin@mci-ot.com or 401-682-8063.

Group Dates

April 14 - 18

Group Location

Portsmouth

Parent/Guardian Name

First Name

Last Name

Child's Legal Name

First Name

Last Name

Email

Phone

(###)

###

####

Child's Date of Birth

MM

DD

YYYY

Please provide any relevant information regarding your child's development, challenges you are currently navigating, or medical history. Additionally, please let us know if they are currently receiving any services such as OT, Speech, or PT.

Child's health insurance provider:

Social Skills Group Sign Up

Sign Up For the Social Skills Group

Convenient Hours

Locations