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Creative Living Program Application

New Creative Living program participants (for GetAway Weekends, After School and all other programs) must complete and submit this form below before registering for specific programs or events.

This enrollment form consists of 5 pages and should take 15 minutes or so to complete. Please have the guest's medical information (doctor, insurance, allergies) and emergency contact information handy.

When you're done, don't forget to use the "Submit" button on the last page to send your information.

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Individual's Information

Please type your full name.

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Please type your full street address.

Please Enter the City Where You Live

Please Choose Your State

Please Enter the Zip Code Where You Live

Please enter your phone number.

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Please enter a valid e-mail address.

Please enter your gender.

Please enter your date of birth.

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Family Information

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Daily Routine and Preferences

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Daily Living Skills

Check all that apply and explain where appropriate

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Meals and Food

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Educational / Leisure / Recreational Interests

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Socialization/Personal Characterization

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Emergency Information

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Please follow the instructions.

Upcoming Events

Friday Nights Out!

Dec 20, 2019
Price: $ 40.00

GetAway Weekend for Women

Jan 3, 2020 - Jan 5, 2020
Price: $ 450.00

GetAway Weekend for Men

Jan 10, 2020 - Jan 12, 2020
Price: $ 450.00

Friday Nights Out!

Jan 17, 2020
Price: $ 40.00

GetAway Weekend for Women

Jan 24, 2020 - Jan 26, 2020
Price: $ 450.00

GetAway Weekend for Men

Jan 31, 2020 - Feb 2, 2020
Price: $ 450.00