Register for a 15-Week Program

Welcome to Integrate for Good’s Programs! We are so glad you have decided to join us.

Step 1: Fill out the form below.

Step 2: Submit Payment.

*If you are new to Integrate For Good, we will have a brief call introducing you to our programs and process to ensure we and the program(s) you selected are a good fit.

Step 3: Mark your calendars for the start of our program! Welcome email will be sent after your paperwork, payment and acceptance has been confirmed.

If you are interested in applying for need based funding, please contact our office at 484-854-1375.

About the Parent/Guardian

First name *

Email address *

Relationship to the Participant *

Last name *

Phone number *

How did you hear about IFG? *

About the Program Participant

Participant First Name *

Date of Birth (MM/DD/YYYY) *

Participant Last Name *

County *

Disability Status *

Which Program(s) Do You Want to Register For? (Hold Control (Ctrl) to Select Multiple Options) *

Has the participant ever worked or volunteered before? *

Yes

No

What are the participant's hobbies, skills, and/or interests? *

Does the participant need any accommodations to make their participation a success? *

Does the participant have any allergies or dietary restrictions? If yes, please share. *

Emergency Contact

First name *

Relationship to the Participant *

Last name *

Phone number *

Anything else you would like our team to know about or discuss further? *

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