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Child and Adolescent Registration - The Papillion Center

Child and Adolescent Registration - The Papillion Center 2025

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4.9 out of 5

23 votes

The document outlines the registration and consent process for clients seeking counseling services at The Papillion Center, which focuses on providing support to children and families in challenging situations. It includes detailed instructions for submitting necessary documentation, client history forms, medical and family history inquiries, financial responsibility agreements, confidentiality policies, and information about equine therapy programs. The aim is to ensure comprehensive care while maintaining client confidentiality and outlining the responsibilities of both the center and the clients.

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Click ‘Get Form’ to open the Child and Adolescent Registration in the editor.
Begin by entering the client's name, including last, first, middle, and nickname. Specify the sex, birth date, age, weight, height, eye color, hair color, and race.
Fill in the details for Parent/Guardian #1. Include their name, relationship to the client, address, phone numbers, email address, and occupation. Indicate if they are the custodial parent.
Repeat step 3 for Parent/Guardian #2. Ensure all information is accurate and complete.
Provide emergency contact information including name, relationship to the child, and phone number.
Complete the insurance information section with details about the primary policyholder and their relationship to the child.
If applicable, fill out financial guarantor information. Ensure that all signatures are provided where required.
Review all entries for accuracy before submitting your form through our platform.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (23 Votes)

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