Summer Evolve 2026 Application
Summer Evolve Details
This application is for the summer only session of Evolve. This program will run 9.5 weeks from June 15th-August 19th. Evolve Summer will run from 9:00am-3:00pm. The location will be at the SOAR Fox Cities Youth Hub: 122 E College Ave. Suite 201 Appleton WI 54911. The rate is $190/day. Registration for first priority closes on March 20th.
1:3 Staffing Ratio
Evolve 365 is an active, heavily community based experience that involves transitioning between activities and locations 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. If you have questions or need further clarification, please contact Abby Miller at (920)731-9831 x 131.
Young Adults Name
*
First Name
Last Name
Date of Birth - Must be between ages of 18 and 30
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Non-Binary
Prefer Not To Answer
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ethnicity
*
African American/Black
Caucasion/White
Native American
Alaskan Native
Asian/Pacific Islander
Hispanic
Unspecified
Other
Parent/Guardian #1 Name
*
First Name
Last Name
Relationship to Youth
*
Mother
Father
Grandparent
Guardian
Other
Parent/Guardian #1 Address
*
Street Address
Street Address Line 2
City
State / 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
*
Email
Phone
Text
Parent/Guardian #2 Name
First Name
Last Name
Relationship to Young Adult
Mother
Father
Grandparent
Guardian
Other
Parent/Guardian #2 Address
Street Address
Street Address Line 2
City
State / 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 Communication Method
Email
Phone
Text
Which parent/guardian should staff contact first during the day while Evolve is in session?
*
Please Select
Parent/Guardian #1
Parent/Guardian #2
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.
*
Yes
No
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 1:4 ratio.
*
Agree
Disagree
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.
*
Yes
No
I give permission for my child to participate in the following activities:
*
Walking Field Trips
Transportation Field Trips
Swimming Field Trips
Other Activities
None
My young adults swimming ability is
*
Please Select
Swims deep
swims shallow
Wades
Fears Water
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?
Yes
No
Only Tattoo
Only Facepaint
Sunscreen/Insect Repellent Permissions: Can be applied by:
Staff
Self
Not Authorized
T-Shirt Size
*
YMCA Membership
SOAR will be purchasing group memberships for Evolve young adults to use during programming. To register for the membership, a waiver form will need to be filled out. The wavier will include basic information like name, emergency contact/phone, and guardian information, etc.
Membership Form
My young adult already has a YMCA pass and can use their personal pass while at SOAR.
SOAR staff are able to help my young adult fill out the form to apply for the pass.
I would like to fill out the form myself (a hard copy can be provided).
I would not like my young adult to apply for a YMCA membership.
WisGo Cards - Valley Transit Usage
Evolve uses Valley Transit to get to and from locations in the community. The public busses now use a system called WisGo which involves a card linked to an individual. Participants who are current AASD students will be able to use their current WisGo card in the summer for Evolve. Participants who are not AASD students will use a general SOAR WisGo card.
*
My young adult has a WisGo card through AASD.
My young adult will use a general SOAR WisGo card.
Transportation To/From Summer Evolve
How will your young adult get to/from Evolve?
*
Parent/Guardian Drop Off
Valley Transit II
Private Cab Company
City Bus
Other
If other, please explain
Third Party Funding Information
We can accommodate third party billing. Please reach out to your case manager and ask them to send an authorization to Amay Forbush (amay@soarfoxcities.com). Please provide us the name and contact information of your care consultant/care manager/case manager as well as your young adult's participation ID number or MCI. An authorization is needed so that we can set up billing. Waivers cannot be billed in advance. If your young adult misses (without cancellation) a week of programming, you will be responsible for paying the fee.
*
Agree
Disagree
Name of Third Party Funder (if none, write "none")
*
Case Manager/Contact Name (if not using third party funding write N/A)
*
Case Manager/Contact Email (if not using third party funding write N/A)
*
Case Manager/Contact Phone Number (if not using third party funding write N/A)
*
Participation ID or MCI (if not using third party funding write N/A)
Cancellation Policy: Any weeks that need to be cancelled must be done with two weeks' notice. Please submit any cancellations in writing to Abby Miller: abbym@soarfoxcities.com.
*
Agree
Disagree
Late Pick Up: The hours of operation for Evolve are 9:00am through 3:00pm, 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.
*
Agree
Disagree
Nonpayment: nonpayment of fees will result in termination of services through Evolve.
*
Agree
Disagree
Emergency Contacts
The following individuals are authorized to help when parents can not be reached, including in emergency situations.
Non-parent/Guardian Emergency Contact #1 Name
*
First Name
Last 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
*
Yes
No
Non-Parent/Guardian Emergency Contact #2 Name
*
First Name
Last 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
*
Yes
No
Medical Information
I authorize SOAR Staff to obtain emergency medical care including transportation for my child to a hospital or other medical facility.
*
Yes
No
Physician Name
*
Physician Phone
*
Cognitive Functioning: check all the apply
*
Cognitive Disability level Mild
Cognitive Disability level Moderate
Attention Deficit Disorder
Mental Health Issues
Autism
Down Syndrome
Other
If other, explain
Physical Conditions: check all that apply
*
Spinal Cord Injury
Visual Impairments
Cerebral Palsy
Stroke
Heart Condition
Epilepsy/Seizure
Asthma
Other
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 Chewing
Choking risk
Stuffs Mouth
Portion Control
None
Socialization
*
Social
Complaint
Helpful
Cautious
Withdrawn/shy
History of Elopement - running from a location
Self Abusive
Clings to Opposite sex
Verbally Aggressive
Physically Aggressive
Other
Triggers: Please list any triggers for behaviors.
*
Explain: Give as much detail as possible, this is very helpful to staff. Please share any behavior plans you use at home as well.
Weekly/Daily Registrations
Evolve is giving the option to register for an entire week or for specific days. If you'd like to register for the full week, please click "select all". If there are certain days in a given week that you'd like to apply for, please only click the specific days.
Week 1: June 15-19
Week 2: June 22-26
Week 3: June 29-July 3
Week 4: July 6-10
Week 5: July 13-17
Week 6: July 20-24
Week 7: July 27-31
Week 8: August 3-7
Week 9: August 10-14
Week 10: August 17-19
The following weeks/days have received 6 or more applications, putting the program at full capacity. Please indicate if you are interested in being on the waitlist for any of these weeks/days.
N/A
ANY CHANGES IN REGISTRATION MUST BE SUBMITTED TO Abby Miller: abbym@soarfoxcities.com.
I understand
Signatures
Parent/Guardian Signature
*
Registration Date
*
Submit
Should be Empty: