Welcome! Thank you for trusting us to step in and help your teen find biblical solutions for what they are facing. We believe it is right and helpful to gain understanding from you and your teen before we impart wisdom, so we ask that you work together to fill out this form. The first part should be completed by the guardian, the second by the minor and the “Registration and Informed Consent” portion together. This form should take no longer than 20 -30 minutes to complete. If you need to stop and continue later, proceed to the bottom of the page and click the link: “Save and continue later.” Please complete this form in its entirety. Items with an asterisk (*) are required.

If this involves family counseling, please have all parties fill out their own forms. We have made this form HIPAA compliment and hold the highest level of confidentiality with the information you provide us. This form will only go to our placement team who will then select a counselor who we believe will best meet your needs.

We are currently taking adolescents 16 and older. While we hope to take children and younger teens in the future, we do not have that availability at this time.

We place new cases on Wednesdays, so please be mindful that it may be up to 6 days before you hear back from us. Thank you and we look forward to serving you.