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This Document Must be Completed by a Parent/Guardian if the Participant is Under the Age of 18
OVERVIEWAt VISIONS, it is our goal to provide an impactful and successful experience for each participant. To support that goal, and to benefit the wellbeing of the participant, it is imperative that all health and behavior information is fully disclosed. A participant will not be registered in a program until this form has been submitted and reviewed by a VISIONS representative. Please note the following:
In some cases, we cannot accept participants with conditions or situations that are incompatible with a program. We want everyone to have access to our programs, and we make all reasonable accommodations toward that end. Nonetheless, some situations require us to deny acceptance, including:
In-patient hospitalization or treatment in the last 12 months from program start date for:
Suicidal ideation/gestures/attempts
Eating disorders
Substance addiction
Violent behavior/legal issues
Active self-injurious behavior
Other mental health hospitalizations
Severe or unstable medical conditions such as seizures, diabetes, and cardiac disorders.
Ongoing concussion symptoms, repeated concussions, or traumatic brain injury within 6 months of program start date.
Living in a foreign environment may create unexpected physical and emotional stress, which may exacerbate otherwise mild conditions. Full disclosure will allow program leaders to be better prepared, and to facilitate a safe and successful experience.
We may require a signed mental health release form, and/or a signed physician release form, and/or a participant action plan for some health and behavior conditions. The VISIONS office will let you know if additional forms are required.
Please contact the VISIONS office before the program start date if there are any changes or updates in health, behavior, or medications.
Prior to acceptance, participants with a history of psychotherapy must be medically stable. VISIONS is not appropriate for applicants who have just completed a residential treatment program.
VISIONS is not a program for youth at risk, and inappropriate placement can be detrimental to the participant and to the program. Behavior issues are subject to reprimand and can lead to dismissal from the program without refund.