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Thank you for your interest in Chapel Haven Schleifer Center!

Please fill out the form below and our Admissions Office will contact you with more information.

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Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • How Did You Hear About Us?
    Details:


  • Would you like to register for a Virtual Info Session?

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    Are you interested in registering for an In-Person Info Session?

    Please note: In-Person Info Sessions begin promptly at 10:00am on the Chapel Haven Schleifer Center campus.
  •  
  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
  • Grade Level of Interest *
    School Year *
  • Current School

  • Student's Primary Diagnosis
    *
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  • Is There Another Student?
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