APPLICATION FORM EIL CHILDREN | PERA MAY WEBSTORE

Emotional Intelligence Lab Enrolment for Children's Lab

Ages 5–6 | 7-9 | 10–12

This program supports children in building emotional literacy: resilience, self-awareness and confidence through creative learning.

Please share a little about your child so I can guide the best placement.

Due to limited availability, not all applications can be accepted immediately. Pera will personally review and be in touch within 24-48 hours. From there all children start with a Discovery Session. Once complete she will advise as to whether she feels 1:1 sessions or joining group sessions will be the best place to start.

Thank you so much for taking the time and considering such a wonderful opportunity for your child's development!

First name

Last name

Phone

Child’s Name & Age

Are you applying for:

Group Lab in Person Christchurch, New Zealand - details below

Group Lab Plus, in person Christchurch (includes access to online community and resources)

1:1 Focus in Person, Christchurch, New Zealand

1:1 Focus Online

Parent Integration (if so it's a seperate form on the Parent Integration Page)

TERM 4 INFORMATION: E.I. LAB Group Sessions - Christchurch Located: at the Climate Action Campus, 180 Avonside Drive, Christchurch. or Home Based Studio (depending on class size) Based in Shirley, near the Palms Mall.

Dates and times:

7-9 YRS GROUP SESSIONS TERM 4:

Thursday's: 3.30 - 5pm 180 Avonside Drive - Climate Action Campus.

5-6 YRS GROUP SESSIONS TERM 4:

Monday: 3.30 - 4.30pm Home Based Studio - Shirley (near the Palms mall). Tuesday's: 3.30 - 5pm

tbc age group - coming soon!

180 Avonside Drive - Climate Action Campus.

Investment: Lab is $35 per session or Lab Plus is $45 - full Term enrolment is required.

Class size 6-8 children per class - they fill up fast! 1:1 Focus both online and in person - Christchurch Located: Christchurch home-based studio in Shirley, near the Palms Mall.

Dates and times:

Monday - Thursday After school sessions open from 3pm - 6pm limited spots avaiable During the day 9am - 3pm most availability - enquire for a time.

Length and Investment: Sessions are 60 minutes $65 per session - full Term enrolment is required. Any questions - there's a box at the end of this form to use.

Are you able to commit to the times/days listed for the option/age group you're applying for? Please note your availability

What has drawn you to this program for your child?

What would you love your child to gain from this experience?

Is your child currently experiencing any emotional, behavioural, sensory, or learning challenges I should be aware of?

Has your child previously worked with any therapist, support worker, or specialist?

Are you prepared to commit to the discovery session $55. Then the full term whilst supporting your child’s integration at home?

How did you hear about this offering?

Do you have any questions?

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