Young Adult Social Group Form
Thank you for your interest in our young adult social groups. Please complete the following information. Your name will be placed on an interest list. As soon as we have new groups available, you will be notified. Once you are notified, you will be able to schedule an intake interview to determine if our program is a good fit for you.
Name
*
First Name
Last Name
Age:
*
Child's age
*
Child's current school grade
*
Parent/Caregiver name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Best contact email
*
example@example.com
Best contact number
*
Please enter a valid phone number.
Format: (000) 000-0000.
A $30 intake fee is charged when you schedule an intake. Will you need this fee waived?
*
Yes
No
Locations
Please indicate below your top two preferred locations:
1st Location Preference
*
Please Select
Katy
Midtown
Spring Branch
Spring/The Woodlands
Sugar Land
2nd Location Preference
*
Please Select
Katy
Midtown
Spring Branch
Spring/The Woodlands
Sugar Land
Submit
Should be Empty: