R.I.S.E Interest Form
🌟 Welcome to RISE Impact Group! RISE stands for Restore, Inspire, Support, and Empower. We are a community-based support program offering services, resources, and therapeutic enrichment for youth and adult families navigating behavioral, emotional, or mental health challenges. Through partnerships with wellness professionals and sports-based programs like cheer, dance, boxing, football, and more, RISE provides structured, empowering opportunities for growth and healing.📋 Instructions for Completing This Form: Fill out all required sections accurately, including your contact information and areas of interest. Select the program(s) you or your child are interested in. Once submitted, a RISE Impact team member will follow up with next steps and help guide you through the enrollment process. Please note: Program approvals are handled by our partnering organization, not RISE staff. Thank you for your interest in RISE—where we help families grow stronger, together!
Applicant Name
*
First Name
Last Name
Applicant Age
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Applicant interest program choice: (Check All That Apply)
*
Rising Stars Academy ~ Dance
Rising Stars Academy ~ Cheer
Rising Stars Academy ~Any RSA Program
Nailtorious Iconz Beauty Academy Licensee Course
RISE After School Programs
RISE Summer Camp
When are you seeking to start class or enroll?
*
ASAP
Not Sure
Other
How did you find out about our programs?
*
Nailtorious Iconz Social Media
Rising Stars Social Media
Nurturing Angels Social Media
Referral
Other
If referred by someone, please list name or social media handle below:
*
Does your child need transportation?
Yes
No
Maybe
What type of medical does the applicant have?
*
Caresource
Buckeye Health
United
Bluecross Blueshield
Aetna
Other
Write a short essay no more than 300 words to explain why applicant should be accepted for the program of interest.
*
Parent/ Guardian Name
First Name
Last Name
E-mail
*
example@example.com
Phone
*
Once you complete the interest form, a member of the RISE Impact Group will contact you with the next steps for your selected program(s).Please note: Program approvals are not determined by RISE Impact staff. While all programs are open to the public, some may require payment if you do not qualify for free services.
*
Yes
Submit Form
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