PROGRAM SIGN UP FORM
EZ  PREVENTION PROGRAM, Inc.
“The New Beginning”
If you are having problems with your child and need assistance now, please contact us today and "reopen" the "lines" of communication. Please read the "criteria" that is used in order for acceptance into our program.  NOTE: Please fill out form completley. Failure to do so, may cause delay.
Please explain, in detail, the reasons and behavior that is being illuminated for you to place your child in our prevention program.  Please be as detail and descriptive as possible.
The following criteria are used to accept angry at-risk youths  into the program:

   • is between the ages of 10-17
    • has NOT spent time in any Youth Correctional facility.
    • does not have multiple offenses in the juvenile  court system.
    • agrees to attend the "entire" program with a parent or legal
      guardian.