CENTERSTONE MENTAL HEALTH INTEREST FORM

CM & CENTERSTONE MENTAL HEALTH INTEREST FORM
Community Montessori is pleased to share a partnership with Centerstone (Phone: 812-258-0310), located in Jeffersonville, for mental health services for our children and teens. Starting November 2022, we will begin virtual therapeutic support with in-person services to be added in 2023. Please fill out this Interest Form for children enrolled in the elementary or teen’s program. Teen learners will walk independently to the Courage Cabin for an online session while elementary age learners will meet virtually in the main building.

Please contact Aimee Joy or Barbara Burke Fondren with additional questions.

Learn more HERE!

*Please Note: We are currently on a waitlist.
Date*

MonthDayYear
Date
Learner's Name*
Teacher/Studio*
Date of birth*

MonthDayYear
Date
Gender at Birth*
Grade Enrolled*
Address*
City*
State*
Zip Code*
Parent/Guardian Name*
Parent/Guardian Phone*
Insurance Provider information*
Reason for mental health services (Once you submit, this information will be shared with the school liaisons and Centerstone all information will be kept confidential):*
Should be Empty:

CM & CENTERSTONE MENTAL HEALTH INTEREST FORM