Lego Group Registration Form

* Required

Open to young people aged 8-14 who experience difficulties with communication, social development, anxiety and depression.

1. Child's Name *

2. Your Name *

3. What is your relationship to the child? *

4. Your contact phone number *

5. Is the child a current patient at CBT Professionals or Solutions for Life Psychology? *

6. Your email address *

7. Billing *

What group(s) are you registering for? *

or relationship 1. Child's

11. Do you have any specific access requirements or considerations for participation? (Optional) *

12. Would you like to receive updates regarding future LEGO® Groups? *

Send us a message

Name *

E-mail or Comment

E-mail address *

Phone Number:

Comment or Message *

Homeworld Helensvale
Shop 51, 502 Hope Island Road
Helensvale, Qld 4212

Prana Centre
Suite 3, 832 Southport-Nerang Road
Nerang QLD 4211

Mt Gravatt Medical Precinct
SE 105, 1808 Logan Rd
Upper Mount Gravatt QLD 4122

Name: *

E-mail *

Phone:

Name: Comment

Comment or Message *

Comment

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