Wings Application

New Member Process
To be a member in Wings Program, applicant must be able to walk on their own, manage own toileting, feed themselves, and get along with others. The Application Process, in order is: 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
Address*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Name*
Prefix First Last
Relationship to Applicant*
Email*
Cell Phone*
Additional Parent/Guardian Name [if applicable]
First Last
Relationship to Applicant
Email
Cell Phone

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