Wings Application

New Member Process
In Order: Complete Member Application, Program Tour, Interview with Staff, 30-Day Trial Period, Full Acceptance into Day Program
Applicant’s Name*
First Last
Birthdate*
Gender*
- Male
- Female
Parent/Guardian Name*
Prefix First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Cell Phone*

Emergency Contact
In the event of an emergency, the following person may be called and is authorized to pick up the above-named individual. Positive ID must be provided before the individual can be released.
Name*
Prefix First Last
Relationship*
Home Phone
Cell Phone*
Other Phone (ie Work)
Any Known Food Alleriges/Dietary Restrictions:*
Please list and describe any additional information of which we should be aware:*

I am signing as applicants*
- PARENT
- GUARDIAN
Parent/Guardian Signature*
I affirm that the preceding information is a complete and true statement of all the facts and circumstances relative to this member’s application for enrollment in any WINGS program. I also understand that submission of this form in no way guarantees placement in any WINGS program, but is merely intended to express interest in the possibility of future participation.
Prefix First Last
Date*
Date Format: DD slash MM slash YYYY

New Member Process