Waitlist Application

Thank you for your interest in Raven Rock Ranch.  This form is NOT an intake. This application is to have your child placed on our waitlist; we serve children ages 7-18 years old.  We make every possible effort to provide services, but completion of this form does not guarantee a weekly time session slot.

Child Information

Child Name

Date of Birth

Relationship to you

School Attended

Guardian Information

Your Name

Address

City

State

Zip

Phone Number

Your Email (required)

Scheduling Conflicts, or other important information