Saint Joseph's Children's Home

 

Saint Joseph's Children's Home

DOCUMENTS AND FORMS FOR ADMISSION

  • Admission Application (Signature Required)
  • Consent and Authorization (Signature Required)
  • Restraints and Seclusions (Signature Required to verify that you were informed)
  • Professional Disclosure Statement (Signature Required verifying that you were informed)
  • Notice of Information Practices Acknowledgement (Signature Required to verify that you received the information)
  • Authorization of Release of Information for Psychiatrist (Signature Required and witnessed)
  • Authorization of Release of Information (Signature Required and witnessed)
  • Permission for Visitation (Signature Required)
  • Consent for Religious Activities (Signature Required)
  • Suggested Clothing List (No signature required - yours to keep)
  • Child Behavior Checklist (CBCL) (Will be sent separately; to be completed by parent or most recent caregiver)
  • Social History (Must be completed by parent or relative)

Please complete the forms and return to St. Joseph's Children's Home as soon as possible.  If you have questions or want further clarification on use/purpose of any of the forms, contact:

Director of Admissions
PO Box 1117
Torrington, WY 82240
Telephone: 307-532-4197
Fax: 307-532-4024
Email: referrals@stjoseph-wy.org 

ADMISSION APPLICATION
SOCIAL HISTORY