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Search for:
About
Services
Clinic
Teletherapy
Summer Programs
Blog
Resources
Contact
What We Treat
Employment/Volunteering
Referral Form
About
Services
Clinic
Teletherapy
Summer Programs
Blog
Resources
Contact
What We Treat
Employment/Volunteering
Referral Form
06-Summer Programs- Language Enrichment (2-5)
Narissa
2025-03-31T19:34:47-07:00
Language Enrichment for Ages 2–5
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Name
*
First
Last
Email
*
Phone
*
Child's First Name
*
Child's Birthday
1. Does your child enjoy playing with other children?
Yes
No
play new What
2. Can your child follow simple routines with minimal support (e.g., sitting in a circle, taking turns, cleaning up)?
Yes
No
3. Does your child participate in group activities like singing, movement games, or storytime?
Yes
No
4. Does your child follow simple directions (e.g., “Get your shoes,” “Put the toy in the box”)?
Yes
No
5. Can your child answer basic “what” and “where” questions?
Yes
No
6. Does your child recognize and name common objects, people, or pictures in books?
Yes
No
7. Does your child use words or phrases to communicate needs and wants?
Yes
No
8. Does your child combine words into short phrases or sentences?
Yes
No
9. Does your child enjoy listening to stories? (For 4–5-year-olds: Do they ask or answer questions about the story?)
Yes
No
10. Does your child participate in pretend play and use language during play?
Yes
No
11. Does your child attempt to copy or repeat new words or phrases they hear?
Yes
No
12. Can your child stay focused on an activity for several minutes without getting distracted?
Yes
No
13. Can your child wait for their turn during group activities?
Yes
No
14. Does your child currently have an Individualized Education Program (IEP) or receive services through the school district?
Yes
No
Not Sure
15. Does your child use any communication supports (e.g., AAC device, picture board, sign language)?
Yes
No
Occasionally
16. How does your child regulate their body during moments of frustration?
17. How does your child engage and interact with same-aged peers?
18. What are your goals or hopes for your child by participating in this group?
19. Are there any strategies, supports, or routines that work well for your child during group or structured activities?
20. Anything else you’d like to tell us that would help us get to know your child better?
Program Goals
*
Enhance language / vocabulary
Improve social communication skills
Boost confidence in expressing ideas
Select the goals you wish to achieve through this program.
How did you hear about us?
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