You can refer a child by filling
our Pre-placement Information Packet and fax or mail it to us. Download
Pre-placement Information Packet and print it.
Download Admissions Packet
- revised 02/06/2015 (right click, save target as)
In this packet you will find an Authorization to Release Information form.
We need one separate form for medical, dental, school, psychiatry, therapy and
court. One copy of this form exists in the Pre-placement Information Packet. You
can download this form separately and print as many copies as you need.
Download authorization_release_form.pdf (right click, save target as)
You need Adobe acrobat reader to view and print these forms.
If you don't have Adobe acrobat reader, you can download it there
For any complementary information about referring a client to us, contact Keith
Ingram Marketing and Referral Manager.
The Family Center of Hope
P.O. Box 752
Hayes, VA. 23072