Referral Request

Name

Phone

Address

Please contact me about:

Contact me when the Ages 0 - 5 Morning Program re-opens

Parent Implemented Intervention - tutoring and behavioral consultations

When Peace Place starts In-Home Respite Care, contact me.

Parent Support Group online - let me know when it starts again

Summer Art Camp June 15-18 (ages 5-8) OR June 22-25 (ages 9-12)

Summer Nature Camp July 6-9 (ages 9-12) OR July 13-16 (ages 5-8)

Other

Please briefly share the name and age of the child/ren if you are asking about our respite programs. (Optional- please do not share health information through this portal - not secure)

If you do not receive a call, please call us at 406-590-4925! (Some weeks are busier than others!)

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Referral Request

Summer 2020