Kidz Connect Intake

Start the Intake Process

Not sure which group is right for your child? You don’t have to figure it out on your own. Tell us about your child and our team will help determine whether Kidz Connect is a good fit and, if so, which group may offer the best peer experience.

How Enrollment Works

1. Complete the Intake Form

Tell us about your child’s communication, social skills, interests, school experience, group participation, and support needs. It takes a few minutes and there are no wrong answers.

2. Our Team Reviews the Information

We look beyond age to consider your child’s current skills, level of support, and potential peer matches.

3. Brief Screening, If Needed

We may contact you for additional information or recommend a brief screening before placement.

4. We Recommend a Group

If we believe Kidz Connect is appropriate, we’ll recommend the group that we feel gives your child the best opportunity to participate, connect, and be successful.

Placement in a particular group is not guaranteed and depends on group readiness, peer compatibility, support needs, enrollment, and available space.

Kidz Connect Intake Form

Tell us about your child.

Our team reviews every submission personally.

Please enable JavaScript in your browser to complete this form.

About You

Parent / Caregiver Name *

First

Last

Email *

Phone *

Preferred contact method

• Email
• Phone
• Either is fine

How did you hear about Kidz Connect?Google or web searchOur websiteSocial mediaA friend or family memberMy child's schoolAnother providerTEAM Behavioral ConsultantsOther

About Your Child

Child's first name and last initial *

Child's date of birth *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Used to help place your child in the right age group.

School setting *Not yet in schoolPreschool or Pre-KGeneral educationInclusion or co-taughtSpecial education classHomeschoolOther

Grade

If applicable.

Communication

There are no wrong answers here. We ask so we can match your child with a group where they will be understood and supported.

How does your child communicate most of the time? *

• Spoken language
• AAC device
• Picture exchange
• Gestures
• Signs
• A combination

Tell us more about how your child communicates

If your child uses an AAC device or another system, let us know which one. Please send it with them so they have access to their communication during group.

Can your child communicate basic wants and needs? *

• Usually independently
• With some support
• We are working on it

Group Readiness

Children do not need to have mastered these skills — these are the skills Kidz Connect is here to help strengthen. Answer with what is typical for your child today.

Participates in a small group with adult support *IndependentlyWith some supportWith a lot of supportNot yet

Engages in an activity for a short period *IndependentlyWith some supportWith a lot of supportNot yet

Follows simple group directions *IndependentlyWith some supportWith a lot of supportNot yet

Transitions between activities *IndependentlyWith some supportWith a lot of supportNot yet

Plays near or with peers *IndependentlyWith some supportWith a lot of supportNot yet

Waits and takes turns briefly *IndependentlyWith some supportWith a lot of supportNot yet

Support Needs

communicates child your

Does your child currently receive 1:1 support at school or in therapy? *

• Yes
• No
• Sometimes

Does your child require continuous 1:1 support to participate safely in a group? *

• Yes
• No
• Not sure

Kidz Connect does not provide continuous 1:1 behavioral support. Needing some prompting or modeling is absolutely fine.

Kidz Connect is a drop-off program. Does your child separate from a caregiver comfortably? *

• Yes
• No
• Sometimes

Anything we should know to keep your child safe and supported?

Allergies, sensory needs, elopement, medical considerations, or anything else our team should be aware of.

What Your Child Loves

Tell us about your child's interests *

We use this to plan activities and to think about peer matches. The more specific the better.

Location & Availability

Preferred location *

• Flanders, NJ
• Augusta, NJ (coming soon)
• Either

When are you generally available?

• Weekday afternoons
• Weekday evenings
• Saturday mornings
• Flexible

Anything else you would like us to know?

SUBMIT INTAKE FORM