2025/26 Adult Registration Form
(Ages 18+)
2025/26 Adult Registration Form (Ages 18+)
Please complete this form in it’s entirety and be as detailed as possible as this is the information we share with our program staff and therapists. Some of our programs partially rely on grants for funding, and certain pieces of information are collected for the purpose of required grant reporting. Client privacy protection will be observed in accordance with those rules set forth in the Health Insurance Portability and Accountability Act (HIPPA).