Tour Booking Page
We are delighted to have you schedule a tour with us. Please complete the below:
We are delighted to have you schedule a tour with us. Please complete the below:
Applicant_First_Name
*
Applicant_Last_Name
*
Date_of_Birth
*
mm/dd/yyyy
Gender
*
Female
Male
Unknown
Was our new applicant diagnosed with Autism?
*
Yes
No
Specialty Program you would like to tour:
*
Kaleidoscope Program- Fayetteville
Kaleidoscope Program- Greensboro
Kaleidoscope Program- Pinehurst
In the event we need to contact you regarding your appointment, please provide the following:
In the event we need to contact you regarding your appointment, please provide the following:
Responsible_Party
*
Mother
Father
Sibling
Aunt
Uncle
Stepfather
Stepmother
Grandmother
Grandfather
Legal_Guardian
Social_Worker
IDD_Coordinator
Other
First_Name
*
Last_Name
*
Primary_Phone
*
Phone
Email
*
*
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