Application Page

Please answer the questionnaire below completely and click SUBMIT.

* Indicates required field

Your Name *

First

Last

Your child/family members name *

First

Last

Child/Family member's Date of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

What is your child's/family member's diagnosis? *

How many days a week are you interested in securing? *

Would you like to be added to our waiting list? *

Yes Not at this time

Tuition is currently $90/day. Will you be paying privately or through NOW/COMP waiver funding? (We are approved to accept self-direct waiver funding) *

I will be paying privately I have completed the course and my child/family member's waiver funding is participant directed.

If you are paying through NOW/COMP waiver, who is your fiscal agency? (Please indicate N/A if planning to pay privately) *

Please upload a photo of your child/family member *

Max file size: 20MB

Describe your child's/family member's level of independence (eating, toileting, etc.), personality traits, ability to communicate verbally, etc. *

In your best words, describe what your child's current days look like. (EX: employment history if any, helpful around the house, participates in group activities, hobbies, likes/dislikes, stays home/active outside the home, etc.) *

What day programs or camps (if any) has your child/family member attended? *

Do you have a current or past teacher, employer, Sunday school teacher, coach, camp counselor, or family friends that could give us an idea of how your child/family member has participated in organized activities in the past? *

How did you hear about The FUN Club? (Friend, recommendation, web search, social media, etc.) *

I hereby confirm that all the information provided about my child or family member, as listed above, is entirely accurate and reflects the current circumstances. I understand the importance of honesty in this process and recognize that any dishonesty or misinformation will not secure admission into The Friends U Need Club for my child or family member. It is crucial that all details are truthful and up to date to ensure the best possible experience and support for my child within The FUN Club. I appreciate the integrity of the admission process and commit to providing only accurate information. I acknowledge and understand that omitting and/or providing false information regarding the health, abilities, behavior, etc. of the individual on this form constitutes grounds for immediate termination of membership.

*I have read and acknowledge the terms and conditions listed above. *

I agree

SUBMIT