FORMS FOR FAMILIES

Completed forms may be faxed to: (919) 287-2950 
or
scanned to: burkelittlencva@gmail.com

1. Child and Adolescent Application for Services

“I will always be grateful for your rescuing my child. Please know that your kind guidance is a blessing that I am thankful for every day.”

Parent of a 17-year-old

2. Young Adult Application for Services

3. Release Authorization

4. Questions for Parents to ask a Program

My husband and I are are eternally grateful for you. You were the force behind our son’s healing and getting our family back. We don’t ever take our great fortune in finding you for granted!”

Parents of an adolescent