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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

GetAway Weekend for Men

Jul 26, 2019 - Jul 28, 2019
Price: $ 450.00

Summer Friday Night Out!

Jul 26, 2019
Price: $ 40.00

GetAway Weekend for Women

Aug 2, 2019 - Aug 4, 2019
Price: $ 450.00

GetAway Weekend for Men

Aug 9, 2019 - Aug 11, 2019
Price: $ 450.00

GetAway Weekend for Women

Aug 16, 2019 - Aug 18, 2019
Price: $ 450.00

Women's Overnight Vacation Week Camp (Co-ed Day)

Aug 19, 2019 - Aug 23, 2019
Price: $ 150.00