Day Program Registration Form

Thank you for your interest in our Day Program!

To help us provide the best service to our clients, please complete the following form for each individual you wish you register. ACRES staff will get in touch with you shortly.

Please list names, ages, and relationships of any family members of the client.

How does the client communicate?

Describe the client's typical daily activities (work, school, extracurriculars, etc.)

If the client has any aggressive behaviors or requires safety precautions, please describe them here.

Describe the client's interests, hobbies, desired activities, likes, etc.

Does the client display certain behaviors when stressed or uncomfortable?

What are the goals of the client for this program?

What family goals should we work towards?

Complete the captcha please.