Please complete all questions below. This is the first step in the intake and admission process. If your child appears to be an appropriate fit for our program, a member of our team will contact you regarding next steps, which will include a tour, an on-site assessment, and completion of participation and financial documentation.

Families applying for assistance through Good Days Foundation, Inc. should note that the review and approval process may take up to thirty (30) days. In certain situations, an emergency board review may be requested.

Placement availability and program start dates may vary based on staffing, scheduling, and program capacity.

Please review all agreement terms before submitting your participation application.

PARENT/GUARDIAN INFORMATION

CHILD'S INFORMATION

Documents Required to Be Provided Before Start:

• Copy of recent IEP or 504 Plan (if applicable)

• Medical Clearance or physical

• Guardianship/Custody documentation (if applicable)

• Insurance Information (if applicable)

PARENT/GUARDIAN AGREEMENT

By submitting this form, I certify that the information provided is accurate, complete, and truthful to the best of my knowledge. I understand that this application is part of the initial intake process and does not constitute acceptance or guarantee of program participation. I acknowledge that Good Days Adolescent Special Needs Center may require additional documentation, evaluation, or verification prior to making any determination regarding program participation.

By signing and submitting this application, I confirm that I have received, reviewed, and fully understand the "Program Participation & Tuition Agreement (A5)", and I agree to be bound by all terms and conditions contained therein.