Join Our Waitlist

Our program is starting with a small group to ensure each participant receives the support they deserve. Join our waitlist today to be notified when a space becomes available and secure your spot for future enrollment.

Currently, we only accept individuals over the age of 18. We encourage parents of children aged 15 and above to still submit the waitlist form. However, those with children younger than 15 should keep us in mind until the child reaches 15.

Full Name of Participant

Date of Birth

Current Age (currently, we are accepting 18+ but we encourage those 15+ to apply)

Gender

Male Female Other

Email Address

Phone Number

Mailing Address

Communication Needs

Is the participant able to use the bathroom independently?

Additional Notes