Reach North West

Thank you for visiting us and applying for a placement on our ‘Let’s Communicate Course’

We are the only multi-disciplinary bespoke parent and child training scheme in the North West that support and teach parents, empowering parents and enabling them to work on targets at home. The course is located in Bolton every Saturday for a 5 week period plus training days.

The cost for the course for you and your child will be £185, This includes the meet and greet, parent training day, access to our private consultant and speech and language therapist, the 5 week course and home activities.

The course requires parents to attend with their child every week (one parent or both parents can attend, the course runs on consecutive Saturday’s - Date will be confirmed due to Covid -19 we have no fixed date as yet

Please enter your Contact Information

First Name*

Please let us know your name.

Email Address*

Please let us know your email address.

Address*

Invalid Input

Post Code*

Invalid Input

Last Name*

Invalid Input

Phone Number*

Invalid Input

City/Town*

Invalid Input

Communication Information

Please tick all those relevant to your child.

Child has no form of communication in place (this includes, Sign, Makaton, PECS, Speech)

Child has started phase one PECS

Child is Pre-verbal (Gestures/points only)

Child has basic verbal communication (1 word utterances/approximations)

Child has emerging verbal communication (2 key word or phrases)

Child has started to use an ACC system (such as prolo2go)

Invalid Input

Please give us more information and explain the way your child communicates

Invalid Input

Would you like us to put your child's name down for the next available course? There are 12 places available for each course and if there are no spaces left we will put you on the waiting list.*

YesNo

Invalid Input

Your child will need to attend a 20/30 minute ‘Meet and Greet’ before starting the course, also a detailed questionnaire and/or paperwork must be filled in prior to the ‘Meet and Greet’ date which is accessed via the website. Children will not be able to attend the course without this paperwork, do you agree to fill this in within the time frame given which will be sent in the placement confirmation email? And agree to happily attend the ‘Meet and Greet’ day.

I agree to fill the in the questionnaire and agree to attend the ‘Meet and Greet’ day

Yes I Agree

Invalid Input

Childs Information

Childs Name*

Invalid Input

Date Of Birth*

Invalid Input

Age of Child*

Invalid Input

Gender*

Invalid Input

Has your child had PBS or ABA before? (Positive Behaviour support/Applied behaviour analysis)*

YesNo

Invalid Input

If You Answered 'Yes' For How Long?

Invalid Input

Under which Consultancy?

Invalid Input

Has your child had SaLT (speech and language therapy)*

YesNo

Invalid Input

If 'Yes' for how long?

Invalid Input

Under which SaLT? (Speech and language therapist)

Invalid Input

Please can you provide the name/s the parent/s that will be attending the course working with their child each week one to one. (Please note only the parents can attend, we can not accommodate other family members due to space and due to it being too overwhelming for some of our autistic children attending the course)

Parents Name*

Invalid Input

Relationship To Child*

Invalid Input

Further Information

Do you agree to pay the £85 non-refundable deposit to secure a placement (this is refundable if we cancel the course for any reason and non-refundable if you take a placement then decide not to attend) *

I Agree

Invalid Input

The course is a 5 week course plus one 30 Minute ‘Meet and Greet’ plus a training day prior to the course starting, by accepting a placement you are agreeing to attend the full course plus the meet and greet and the training day please tick that you agree*

I Agree

Invalid Input

Please tick to confirm that if you decide the course is not for you will you please do let us know as we always have a waiting list (*) I agree to inform you asap if I do not want a place when offered and understand the course deposit is non-refundable.*

I Agree

Invalid Input

Reach North West is a voluntary group that rely on supporters and volunteers. Would you be able to help in any of the following ways?

Please tick those you can help out with.

If you answered 'Other' above please leave details.

Invalid Input

If you have any other questions please use this box

Invalid Input

How Did You Hear About REACH North West? Please be specific (Eg GP, School teacher, if Facebook, which group/page or friend, the more information the better – this helps us REACH and support more families.

Invalid Input

Thank you for visiting us and applying for a placement on our ‘Let’s Communicate Course’

Please enter your Contact Information

Communication Information

Childs Information

Further Information

REACH North West. All rights reserved