Evolve Transition Days 2025

Evolve Application

SOAR Fox Cities Main Office: 211 E Franklin St., Appleton, WI 54911 // SOAR Fox Cities Youth Hub: 122 E College Ave. Suite 201, Appleton, WI 54911
1:3 Staffing Ratio

Evolve is an active, heavily community based experience that involves transitioning from activity and location frequently. Young adults between the ages of 18 and 23 who are appropriate for this group should be mostly independent with transitions and have appropriate behavior for a 1:3 staff to young adult ratio.
Evolve Program Details

Evolve will run two separate sessions this summer with 2 staff and 6 young adults each. One session will be at the Main SOAR office at 211 E Franklin St. The other location will be the SOAR Youth Hub on the second floor of downtown Appleton's city center, 122 E. College Ave. Evolve will maintain a 1:3 staffing ratio.
***After registration closes, young adults will be placed into groups by location.***

We are unable to accommodate location requests. Please watch for information via email and regular mail for young adults' location and confirmation of dates.
Young Adults Name*

First NameLast Name
Date of Birth - Must be between ages of 18 and 23*

MonthDayYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ethnicity*

African American/BlackCaucasion/WhiteNative AmericanAlaskan NativeAsian/Pacific IslanderHispanicUnspecifiedOther
T-Shirt Size*
My young adult has permission to participate in swimming on field trips. *
My young adults swimming ability is*
Parent/Guardian #1 Name*

First NameLast Name
Relationship to youth*

MotherFatherGrandparentGuardianOther
Parent/Guardian #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1 Mobile Phone Number*
Please enter a valid phone number.
Parent/Guardian #1 Second Phone Number
Please enter a valid phone number.
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #1 Place of employment if applicable
Parent/Guardian #1 preferred Communication Method*

EmailPhoneText
Parent/Guardian #2 Name

First NameLast Name
Relationship to young adult

MotherFatherGrandparentGuardianOther
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Mobile Number
Please enter a valid phone number.
Parent/Guardian #2 Second Phone Number
Please enter a valid phone number.
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 preferred way of communication.

EmailPhoneText
Which parent/guardian should staff contact first during the day while Evolve is in session?*
Acknowledgement and Permissions

Available upon request.
Hold Harmless agreement: I indemnify and hold harmless SOAR Fox Cities, any of its employees and/or agents from all claims from my use of SOAR property or participation in any programs. I will further indemnify and hold harmless SOAR Fox Cities, its employees and/or agents from all costs, expenses and liabilities resulting from any claim brought from my child(ren)’s use of SOAR property and/or participation in SOAR programs to the extent of SOAR's liability under general law.*

YesNo
Admission: Parents have duty to share significant medical, physical or behavioral needs at time of application. Should there be a significant behavior situation, Evolve staff reserve the right to have a young adult return home. Due to group format, Evolve is unable to provide one-on-one care. Young Adults must be able to transition. Evolve will provide a maximum of of 1:3 ratio.*

AgreeDisagree
Image Authorization: I authorize SOAR Fox Cities to use any photographs or videos taken of my child for promotional reasons including website, social media, brochures, flyers or newsletter.*

YesNo
Sunscreen/Insect Repellent permissions: can be applied by*

StaffSelfNot Authorized
I give permission for my child to participate in the following activities:*

Walking Field TripsTransportation Field TripsOther ActivitiesNone
Do you give SOAR Fox Cities permission to apply temporary tattoos or face paint as part of the programming and if the young adult wishes to participate?

YesNoOnly TattooOnly Facepaint
Third Party Funding Information
We can accommodate third party billing. Please reach out to your case manager for authorization, and then provide us the name and contact information of your care consultant, care manager, or case manager, participation ID number or MCI, and a copy of your authorization so we can setup billing. Send all information to Amay Forbush: amay@soarfoxcities.com. Waivers cannot be billed in advance. If your child misses (without cancellation) a week of programming, you will be responsible to pay the fee.*

AgreeDisagree
Name of Third Party Funder (if none, write "none")*
Case Manager/Contact Name*
Case Manager/Contact Email*
Case Manager/Contact Phone Number*
Cancelation Policy: Any weeks that need to be canceled must be done with two weeks' notice. Please submit any cancelations in writing to Lisa McCallister: lisa@soarfoxcities.com.*

AgreeDisagree
Late Pick Up: The hours of operation for Evolve are 9am through 3pm, Monday through Friday. A late fee of $15.00 per 15 minute increment will be charged after 3:00pm. Our policy will be to round up so if you pick up your child at 3:10pm you will be charged a $15.00 late fee; If you pick up your child at 3:18pm you will be charged $30.00. The late fee is due before drop off on the next day of care. We reserve the right to bill third party payees.*

AgreeDisagree
Emergency Contacts

Following Individuals are authorized to help when parents can not be reached including emergency situations.
Non-parent/Guardian Emergency Contact #1 Name*

First NameLast Name
Emergency Contact #1 Primary Phone*
Please enter a valid phone number.
Emergency Contact #1 Secondary Phone
Please enter a valid phone number.
Emergency Contact #1 Authorized To Pick Up*

YesNo
Non-Parent/Guardian Emergency Contact #2 Name*

First NameLast Name
Emergency Contact #2 Primary Phone*
Please enter a valid phone number.
Emergency Contact #2 Secondary Phone
Please enter a valid phone number.
Emergency Contact #2 Authorized To Pick Up*

YesNo
I understand that ONLY persons on the “Authorized Person(s)” list will be allowed to pick up my child and that they and I will be required to present photo identification until staff recognize parent/guardian/emergency contact, before my child is released. Should someone else need to pick up my child, parent/guardian must provide written notification. This person will need to show photo identification to pick up as well.*

AgreeDisagree
Medical Information
I authorize SOAR Staff to obtain emergency medical care including transportation for my child to a hospital or other medical facility.*

YesNo
Physician Name*
Physician Phone*
Cognitive Functioning: check all the apply*

Cognitive Disability level MildCognitive Disability level ModerateAttention Deficit DisorderMental Health IssuesAutismDown SyndromeOther
If other, explain
Physical Conditions: check all that apply*

Spinal Cord InjuryVisual ImpairmentsCerebral PalsyStrokeHeart ConditionEpilepsy/SeizureAsthmaOther
If yes to Epilepsy, please give details of type, frequency, date of last seizure and treatment
If other, explain
Specify Food Allergies: if none, write NKA (no known allergies)*
Specify Non-Food Allergies: if none, write NKA (no known allergies)*
Eating*

Difficulty ChewingChoking riskStuffs MouthPortion ControlNone
Socialization*

SocialComplaintHelpfulCautiousWithdrawn/shyHistory of Elopement - running from a locationSelf AbusiveClings to Opposite sexVerbally AggressivePhysically AggressiveOther
Triggers: Please list any triggers for behaviors. *
Explain: Give as much detail as possible, this is very helpful to summer staff. Please share any behavior plans you use at home as well.
Conditions of Evolve Attendance

Select Agree to indicate your agreement with each condition.
Nonpayment: nonpayment of weekly fees will result in termination of services through Evolve.*

AgreeDisagree
Friends in Evolve
Do you have a friend attending? Please list their name; we will do our best to assign both young adults to the same location. If you do not have a name to enter, please type none. *
Weekly/Daily Registrations

Evolve is giving the option to register for an entire week OR by day. If you choose to register for select days, the options will appear when "Select Days' is checked under each week.
June 16-20, 2025

Select Days
Please Select Your Days

Thursday, June 19, 2025
June 23-27, 2025

Select Days
Please Select Your Days

Monday, June 23, 2025Tuesday, June 24, 2025Wednesday, June 25, 2025Thursday, June 26, 2025
July 7-11, 2025

Full WeekSelect Days
Please Select Your Days

Monday, July 7, 2025Tuesday, July 8, 2025Wednesday July, 9, 2025Thursday, July 10, 2025Friday, July 11, 2025
July 14-18, 2025

Select Days
Please Select Your Days

Monday, July 14, 2025Tuesday, July 15, 2025Thursday, July 17, 2025
July 21-25, 2025

Select Days
Please Select Your Days

Thursday, July 24, 2025
July 28-August 1, 2025

Select Days
Please Select Your Days

Thursday, July 31, 2025Friday, August 1, 2025
August 4-8, 2025

Select Days
Please Select Your Days

Tuesday, August 5, 2025Thursday, August 7, 2025
August 11-15, 2025

Select Days
Please Select Your Days

Tuesday, August 12, 2025Thursday, August 14, 2025
Full-Capacity weeks and Days- the following weeks and days have received 15 or more applications, putting the program at full capacity. Please still indicate if you are interested in these weeks, as we are a BEST FIT, not first come program.

Full Week - June 16-20Monday, June 16, 2025Tuesday, June 17, 2025Wednesday, June 18, 2025Friday, June 20, 2025Full Week - June 23-27Friday, June 27, 2025Full Week - June 30-July3, 2025Tuesday July 1Wednesday July 2Thursday July 3Full Week- July 14-18, 2025Wednesday, July 16, 2025Friday, July 18, 2025Full Week- July 21-25, 2025Monday, July 21, 2025Tuesday, July 22, 2025Wednesday, July 23, 2025Friday, July 25, 2025Full Week- July 28-August 1, 2025Monday, July 28, 2025Tuesday, July 29, 2025Wednesday, July 30, 2025Full Week- August 4-8, 2025Monday, August 4, 2025Wednesday, August 6, 2025Friday, August 8, 2025Full Week August 11-15Monday, August 11, 2025Wednesday, August 13, 2025Friday, August 15
ANY CHANGES TO REGISTRATIONS MUST BE SUBMITTED TO Lisa McCallister. Lisa@soarfoxcities.com*

I understand
Signatures
Parent/Guardian Signature*

Clear
Registration Date*
Should be Empty:

Evolve Application

1:3 Staffing Ratio

Evolve Program Details

***After registration closes, young adults will be placed into groups by location.***

Acknowledgement and Permissions

Third Party Funding Information

Emergency Contacts

Medical Information

Conditions of Evolve Attendance

Friends in Evolve

Weekly/Daily Registrations

Signatures

After registration closes, young adults will be placed into groups by location.