Brave Buddies Application

Important Information
For multi-day programs, lead-in sessions are crucial because they improve the likelihood of success in the program. Two 60-minute lead-in sessions are included in the cost of the program and take place over two consecutive days prior to the start of the program. If you are coming from out of town, attending the lead-in sessions may impact your travel plans. Depending on the specific needs of your child, your clinician may recommend additional treatment sessions.

Parent training is also a crucial part of Brave Buddies. Parent training is provided each day of the program.

Date of birth*

Primary Caregiver Information

Relationship to Child*

Primary Phone Number*

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Child's name you wish to enroll*

Which of our clinicians does your child see on a regular basis?

Emergency Contact Information

Please be sure to list contacts specific to the dates when your child will be attending brave buddies sessions

Relationship to child*

Please be sure to include all medication information for the dates that your child will be attending brave buddies sessions.

Please provide medication name(s), dosage(s), and administration time(s):

If yes, please explain allergies:

Please list some of your child's favorite things: (i.e. activities, games, topics, toys, color, foods, characters, etc.):*

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Brave Buddies Program

Apply for the Brave Buddies Program

Child Information

Primary Caregiver Information

Emergency Contact Information

Consent to Child Mind Institute Recording My Child

Internet Explorer is no longer supported

Brave Buddies Program

Brave Buddies Application

Apply for the Brave Buddies Program

Child Information

Primary Caregiver Information

Emergency Contact Information

Consent to Child Mind Institute Recording My Child

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