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