Social Group Referral Form. Social Group Referral Form. Social Group Referral Form. Name * First Name Last Name Phone * (###) ### #### Email * Which Group are you interested in? Lego Therapy Sport Group Teen Group - Girls Teen Group - Boys Mens Group - 40+ Group Fishing Group Young Adults - Tuesday Young Adults - Wednesday Lego Therapy - Post 18+ Lego Therapy - Under 12's Lego Therapy - 12-17 What School Grade? * Communication Levels Verbal - no assistance Verbal – shortened sentences Verbal – one word answers Hand gestures/pointing AAC or other visuals Non-verbal What types of behaviours does this person present with? * Any Restrictive Practices in Place? * If yes - what are they? Thank you!
