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Participant Application


Special Reach Inc. is honored to serve children with developmental delays ages 6 years to 18 years old and their siblings ages 5 years and older. Applicants must meet certain criteria for each program in order to be eligible to participate in the program.



  1. All applicants with developmental delays must submit a completed application form by clicking on the "Special Needs Application" below:

  2.  Our staff will contact you to schedule an intake.

  3.  You will be required to submit the following documents prior to attending our program. Please click on the "Required Forms Submission Portal" below to download blank forms, complete them and then submit them via the portal:

  • Vaccination Records

  • Participant Release Form

  • Medical Emergency Form

  • Seizure Action Plan (required if the participant has ever had a seizure). Click on button below.

  • Sibling Application Form (required if the participant will be attending with a sibling). Click on button below.

  • Physician Medication Order Form (This form is only needed for our day programs SAAP & Summer).

  • Current photograph of the participant

Children who exhibit extreme versions of the following behaviors will not be eligible for admittance into the Special Reach program.

Physical harm to self or others
• Physical aggression
• Sexual misconduct
• Elopement
• Threats


Click On The Button Below To Complete Application

Application Process

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