Please fill out this form with as much detail as possible. The information you provide will allow us to learn important information about your child and help us meet their needs while facilitating programming. We want to be as helpful as possible, and ensure that we have the proper supports in place. This is a fillable form. Please type in your answers and click "submit" ONCE. If we have any questions regarding your information, we will contact you. All medical/school records will be maintained in a separate file for the privacy of our families.
This form must be completed and submitted within 72 hours of the start of programming. Additionally, all supporting documentation such as diagnosis and behavior plans must accompany this form.
Thank you for your assistance in helping us to provide safe and quality programming at Brandon’s Place.