New Client Registration Form

Please complete and submit the form below

RISE schedules weekly sessions and intensives throughout the year in four seasons and accepts new applicants for each season once an assessment has been completed. Weekend intensives are available during some season for out of town participants.

A. Winter Season = January, February, March (sign ups open December 1st)
B. Spring Season = April, May, June (sign ups open March 1st)
C. Fall Season = September and October (sign ups open August 1st)
D. Holiday Season = November and December (sign ups open October 1st)

Once you complete a New Client Registration Form, you will be contacted with details to schedule an assessment. If you have completed an assessment or are a returning client, please complete the Scheduling Questionnaire and return to info@riserehab.org.

Client Full Name

Client Date of Birth

Client Gender

Client Diagnosis

Client Weight

Client Height

Client School / Employer

Parent / Legal Guardian Full Name

Parent / Legal Guardian Cell Phone

Parent / Legal Guardian Email

Street Address

City

State

Zip Code

Emergency Contact

Emergency Phone

Additional Information

* information is required

New Client Registration Form

THANK YOU FOR YOUR SUPPORT