Pre-Tour Intake Form
Day Program Tour Scheduling & Information
Welcome! We are excited to offer you a tour of our day program. Our goal is for you to observe our team in action and gain a clear understanding of the activities and support we provide.Please complete this form so we can finalize your tour arrangements and follow up with you afterward.
Contact Information
Name of Parent / Guardian
Type your name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
Your email.
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Tour
Preferred Tour Date & Time
Would you like the tour to occur when members are in the building so you can see the team in action?
Please Select
Yes
No
Would you like a hardcopy intake form to take home, or would you prefer a digital copy?
Please Select
Hardcopy Intake Form
Digital Copy
Both
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Transportation
Do you need us to provide school pick-up and drop-off?
Please Select
Yes
No
Pick Up Address. (Type N/A if no transport needed)
*
Drop Off Address. (Type N/A if no transport needed)
*
Please provide the Pick-Up and Drop-Off times for each weekday. Please be very specific. If no transportation is needed, Click N/A.
Rows
Pick-Up Time
Drop-Off Time
No Transport
Monday
Tuesday
Wednesday
Thursday
Friday
Enter any additional information about transportation you’d like us to know.
Type N/A if none.
Are there any special requirements (e.g., wheelchair, walker, medical equipment)?
Type N/A if none.
Submit
Should be Empty: