2025 Rising Lights Project - Adults Intake Form
This intake form is required for all adults involved with Rising Lights Project.

***PLEASE READ*** 
Rising Lights Project is staffed for a 1:4  ratio- one volunteer/staff per 4 attendees. 

By completing this form, you understand that Rising Lights Project is qualified to care for students at a 1:4 ratio.

 We cannot offer 1:1 support. 

If more support is required, Rising Lights Project may not be the right program for your/son daughter.

Members are required to toilet independently, eat independently, manage behavior with little assistance, follow and listen to 1-2 step directions and get along well with others

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Email *
Your Phone Number *
Your Email *
Parent's First and Last Name  *
Student's Email
Today's Date *
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Student's Name
 *
Student's Birthday  *
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Your home address *
Disability Details *
Toileting Needs *
Behavior Concerns *
Allergies  *
Medications
History of Seizures? *
If yes, what is the date of the last seizure?
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If yes, describe type and emergency protocols in the events of a seizure.  
Can your son/daughter follow 1-2 step directions independently? *
How does he/she mostly communicate? *
Likes/Enjoys *
Dislikes? *
Parents Names- First & Last Names *
I understand that Rising Lights Project is an adult program with resources to support adults at a 1:4 ratio. 

I understand that Rising Lights Project can not support my child needs if they require 1:1 support, have severe medical needs and/or have aggressive behaviors.
 *
Emergency Contact *
Emergency Contact *
Anything else you would like us to know? *
Are you okay that RLP uses pictures to post on social media and our website to demonstrate the work we are doing? *
Goals you have for your adult child? *
*For garden group members only* 
In the event your child comes into contact with poison ivy or a bee sting, may we administer Benadryl? 
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Garden Group ONLY

You understand the risks that come along with gardening outdoors. 

Students will be using gardening tools to complete tasks. We will teach proper safety usage and protocol. 

Students will be expose to a number of different plants and flowers. 

Students will be using all 5 senses in the garden. We will have the opportunity to taste a number of items we grow. If you DO NOT want your child to eat food from our garden please list below. 

You understand that bees and insects are in the garden and that we have little control over bees and bugs.
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Rising Lights Project is a privately operated organization committed to providing inclusive, empowering programming for adults with disabilities. As a private entity, we reserve the right to discontinue services at our discretion if circumstances arise that impact the safety, wellbeing, or alignment of a participant with our program values and structure. While we strive to foster open communication and collaborative solutions, decisions regarding continued participation will be made with thoughtful consideration for the individual, staff, and broader community. *
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