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REACH - Online Program

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REACH

CLP

REC

ASAT/CHW

Please list the classes student is interested in *

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ASAT/CHW - Online Program

Student First Name *

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Student Birth Date *

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REACH

CLP

REC

ASAT/CHW

Please list the classes student is interested in *

Parent Contact Information:

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CLP - Online Program

Student First Name *

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REACH

CLP

REC

ASAT/CHW

Please list the classes student is interested in *

Parent Contact Information:

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Stay Safe - Online Program

Student First Name *

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Diagnosis:

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Parent Contact & Billing Information:

Parent First Name *

First

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Address (street address, town, city, zip) *

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Other Emergency Contact:

Emergency Contact name *

Phone *

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Special Needs or Considerations:

Program Interest *

REACH

CLP

REC

ASAT/CHW

Name of class student is applying for: *

Currently enrolled in high school or post-secondary program? If yes, please list school: *

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RecDesk - Online Program

Student First Name *

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REACH

CLP

REC

ASAT/CHW

Please list the classes student is interested in *

Parent Contact & Information:

Parent First Name *

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Wellness - Online Program

Student First Name *

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Student Birth Date *

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REACH

CLP

REC

ASAT/CHW

Please list the classes student is interested in *

Parent Contact & Information:

Parent First Name *

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Chapel Haven Programs

Chapel Haven Schleifer Center

Chapel Haven West

Upcoming Events

Join us Saturday, April 10 for our next virtual open house!

Chapel Haven Schleifer Center

Chapel Haven West

Upcoming Events

Join us Saturday, April 10 for our next virtual open house!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up for classes!

Fill out this form to sign up!

Fill out this form to sign up!

Fill out this form to sign up!