AdaptoPlay

2022 Go Baby Go Referral Form

Please fill out with the CHILDS contact information

Please check "Child" below


PLEASE DOWNLOAD AND UPLOAD IMAGE RELEASE HERE. ALSO CHECK "YES" to the image/event release question

After clicking the upload button be sure to select the drop down menu when searching and select "All Files" to see all file types on your PC. This way PDFs and Word Docs will show up.

PLEASE UPLOAD "GO BABY GO REFERRAL FORM" below


Go Baby Go Referral Form

Please download all forms in the "Downloads" section below, fill out completely, and upload. The referring therapist must complete the GBG Referral Form. The families must sign the IMAGE and EVENT RELEASE and the RELEASE AND WAIVER OF LIABILITY.  All documents must be completed and uploaded to complete. You may either do this digitally on phone or PC - OR - Print, scan, and upload. 

To sign the forms digitally - please download Adobe Acrobat Reader on your phone or PC. 

PLEASE NOTE: DUE TO COVID WE ARE CURRENTLY ONLY ACCEPTING APPLICATIONS FOR THE WAITING LIST FOR 2021.