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- Staff
- 2026 Summer Staff
Services
Enrollments
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Courses
Farm Calendar
Contact Us
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2026-2027 Social Skills Group Enrollment High School ESA+

THIS ENROLLMENT IS ONLY FOR CURRENT ESA+ GRANT RECIPIENTS.

IF THIS DOES NOT APPLY TO YOU, PLEASE CLICK THE BACK ARROW TO THE HOME PAGE AND CLICK YOUR AGE GROUPS ENROLLMENT BUTTON.

We are excited to have you become a part of our BC family! Please make sure to read is this program a good fit for my child before enrolling!

Please choose one of the options below! *

I want to enroll for all 5 sessions for the year and pay monthly! I will be invoiced monthly!
I want to enroll for just one session at a time and will be invoiced for that singular session. (as we have typically done in the past!)

This enrollment is for: *

Fall 1: August 31-October 10, 2026
Fall 2: October 19-December 5, 2026
Winter 1: January 4-February 13, 2027
Spring 1: February 22-April 10, 2027
Spring 2: April 19-May 29, 2027
All Five Sessions

Child's Name *

First

Last

Date of Birth *

Child Resides with: *

Parent(s)
Guardian
Grandparent
Other

Child's Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Age *

Current Grade for the 2026-2027 School Year *

Example: Kindergarten, 1st, 2nd etc.

Current School *

or home school/home school co-op etc.

Current School System County *

Parent/Guardian #1 *

First

Last

Parent/Guardian #1 Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #1 Email *

Parent/Guardian #1 Cell Number *

Parent/Guardian #1 Work Number

Parent/Guardian #2

First

Last

Parent/Guardian #2 Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2 Email

Parent/Guardian #2 Cell Number

Parent/Guardian #2 Work Number

Emergency Contact (Other than Parent) Name *

First

Last

Emergency Contact Phone Number *

Emergency Contact Relationship to Child *

How Did You Hear About Us/Referred By? *

Current Client
Former Client
Facebook
Instagram
Website
Family/Friend*
Provider*
Event*
Training*
School*
Other*

Please Elaborate on Your Above Selection if it is Followed by an Asterisk

Others You know Coming to Group and/or Preferred Peers to be Grouped with:

**We will do our best to accommodate**

Current BC Family Member that Referred Me (NA if not applicable)

Does Your Child Have an Identified Diagnosis/Delay(s)? *

Yes
No

This also includes any medical diagnoses, such as genetic disorders, chronic conditions such as Chron’s disease, diabetes…..as well as Autism/ADHD/Anxiety, etc.

If Yes, Please List

While you are with us you will received feedback/resources to better assist you with your child

Is your child currently taking any daily medication? *

Yes
No

If yes, please list medication dosage, frequency, and reason for taking.

Does Your Child Currently Have an IEP/504 plan? *

Yes
No

If Yes, What Level of Support Does He/She Require at School?

Resource (in General Education mostly, with some pull-out and push in supports)
Curriculum Assistance (CA Class)
Autism Support/Behavioral Support
Separate Setting (in a specially designed classroom such as EBS, ECS etc)
Other

If Other, Please Elaborate

Please answer honestly to the questions below that indicate what type of support your child requires for each area of development! Please note that children that require a HIGH level of support may not be a good fit for our programming.

Language Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Gross Motor Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Emotional Regulation Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Social Engagement

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Transition Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Does Your Child Have Sensory Differences? *

Yes
No

If yes, Please Explain your Child's Sensory Needs

Providers We Are Currently Working With

If We Have Questions or Need More Information for Planning Purposes, Do We Have Your Permission to Reach Out to any of these Providers? *

Yes
No

Please Provide Contact Information for Your Provider (Email/Phone etc)

Does Your Child Have Allergies? (Food/Environmental) *

Yes
No

If Yes, Please Describe or Exchange Their Reaction

Will Your Child be Bringing Medication to Take as an Emergency for these Allergies, such a an EpiPen? *

Yes
No

Please List Medication:

In case of emergencies where a rash and/or hives and swelling /shallow or shortness of breath are present after exposure to allergen (ex: hay/animal/bee sting), we will contact 911 immediately and then call parent and/or emergency contact. *

By checking this box , I am aware of this protocol by Building Connections, LLC.

Food Sensitivities/Dietary Restrictions/Foods my Child can not be Offered (if none, say none): *

My Child has had Exposure to Animals, Particularly Farm Animals *

Yes
No

My Child has some Fears About Animals *

Yes
No

If Yes, Please Explain

We do not force engagement with animals; however, we do encourage children to find a way to have safety awareness of animals and be in a comfortable and safe proximity of them with an adult in their own time!

My child has the following fears regarding the outdoors(ex: bugs, heat, etc): If none, say none. *

My Child’s Interests/Likes: *

My Child Does Not Like or Has Fears of: *

My Child is Comforted by or Things that Make their Brain/Body Feel Better/ “Reset” *

Supports that Maybe Helpful for my Child: *

Triggers For my Child and Behaviors Associated with Them: *

Things that are not helpful strategies for my child and their response: For example, my child doesn’t like to take deep breaths, they will escalate and get louder.

Behaviors Noted at Home/School: *

My Teen has a Phone/Apple Watch/ or Comparable *

Yes
No

My Teen has Good Phone Habits and is Responsible when Managing It *

Yes
No
N/A

If Yes, Please Explain

Does your Teen use their Phone to Listen to Music as a Calming Strategy with Headphones *

Yes
No
N/A

During group, we like to have teens place their phones in a central location where they can use for a time period. If this will cause issues, we ask parents to keep the phones at home. If there is an emergency or need to contact you, we will do that!

Any Other Information You Feel is Important for Staff to Know?

I am interested in enrolling in the supported employment/job coaching program BC CHUCK WAGON *

Confirmation I am Interesting in the BC CHUCK WAGON

Checking this box doesn’t indicate that you will be selected or committed to this program. We are just gauging an interest. You must go through an application, interview, and be willing to work at least 1 day a week during a social skill group (see calendar on home page for days and times)

I acknowledge the importance of parent participation and engagement as a key component of our family’s involvement in BC’s Social Skills Group programming for the 2026-2027 school year *

Confirmation I have read and agree to the above and below information

A key part of social skill group programming is parent participation and engagement! This year, we are requiring at least one parent to attend each class. Each class time will have a short parent component that consists of connection, training, and coaching. There will be one class that is devoted to whole group parent coaching , where teachers coach parents coaching kids/teens! Class time will include practical interventions specific to need/age group, guest speakers, make and takes, parent fun, etc!

By selecting your first, second, third choice, you are indicating that your child would be able to attend any of those options. We do our best to look at availability, but our priority is making sure that your child is in a good fit group!

Select Dates – 1st Choice *

9th-12th Monday 5PM-7PM
9th-12th Thursday 5PM-7PM

Select Dates – 2nd Choice *

9th-12th Monday 5PM-7PM
9th-12th Thursday 5PM-7PM

I have read the Social Skills Group programming information on the website and understand my responsibilities as a parent or guardian as well as Building Connections responsibilities for Social Group programming. I understand that my deposit is non-refundable/non-transferable as well as any payments made towards Social Group programming. I understand that I will be invoiced for the remainder of the balance *

Confirmation I have read the above

As part of placing your child in a good fit group, we may call you to ask more questions so that we understand the needs of your child!

Waiver & Photo Release Completed *

I have completed the waiver and photo release. (link to do so) *All participants need to complete these forms for the new school year (August 26-July 27)

Click Here for Liability & Photo Release Forms

By signing below I agree that I understand that I will be emailed an invoice from Building Connections for the full amount of the checked enrollments above 2 weeks before group starts. Once received, I will submit to ESA within 2 days and ClassWallet will pay in full after submitting. If BC does not receive funds from Classwallet within 2 weeks of submitting the invoice, I am responsible for all of the deposits plus a $150 administrative fee. Building Connections is trusting that by not submitting payment today for 2026/2027 Social Skills Groups that I am doing my part by submitting the invoice promptly two weeks prior to each selected session. * *

Clear Signature

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© 2024 Building Connections. All rights reserved.

Email our office manager for questions: Kidsconnect.bc@gmail.com

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596

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© 2024 Building Connections. All rights reserved.

Email our office manager for questions: Kidsconnect.bc@gmail.com

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596