Unlimited Potential - Amazon Simple Storage Service (S3)
(short fold panel that creates the back of BRM envelope)
Unlimited Potential
For more information or to sign up for CHI St. Joseph Children’s Health Family Wellness Program complete and return the attached request for services form (on the back of this panel) or call 1.844.837.9285.
Providing Your Child and Family Every Opportunity for Success
ENROLLMENT APPLICATION Please print clearly and use pen when completing the application.
Child’s Name: ________________________________________ Address: _____________________________________________ _____________________________________________________ School: ______________________________________________ Grade: ___________________ Teacher: ___________________ Care Giver 1 Name: ___________________________________
Lives with Child:
❑ Yes
❑ No
Phone: __________________________________ H/O/M
Email: __________________________________________
Primary Family Contact:
❑ Yes
❑ No
Best Time To Contact: AM / PM / Evening (Before 8PM) Care Giver 2 Name: ____________________________________
At CHI St. Joseph Children’s Health we believe that every child is filled with unlimited potential…
Lives with Child:
❑ Yes
❑ No
Phone: __________________________________ H/O/M
Email: __________________________________________
Primary Family Contact:
❑ Yes
❑ No
Best Time To Contact: AM / PM / Evening (Before 8PM)
❑W e are requesting that CHI St. Joseph Children’s Health contact us to enroll and participate in the Family Wellness Program. We understand that we may withdraw our request to participate at any time. A member of the staff at CHI St. Joseph Children’s Health will contact us via phone to begin our enrollment in the program.
__________________________________________________________ Parent / Guardian Signature
___________________
Date
(glue strip for sealing envelope)
City: ____________________________ ZIP Code: __________
(inside of BRM envelope)
and that families – of all forms, types and sizes – are the key to unlocking a child’s potential and allowing it to be shared with the world.
1.844.837.9285
Yet, every child and every family is different.
There is not always a right or a wrong. In reality, much of the time it just is. Children do not come with instruction manuals and families do not have admission standards.
The challenge for all of us is figuring out how we belong, how we grow one another and how we free our potential as children, as caregivers or parents and as families.
1.844.837.9285
CHI St. Joseph Children’s Health is here to help. Our innovative family wellness program, which includes individual, family and community-level activities, works with children and families throughout the Lancaster Community.
Let us continue the journey together.
Our team provides families with support, guidance and encouragement as you travel your child’s and your family’s unique path to health, wellness and happiness.
1.844.837.9285
All families enrolled in the Family Wellness Program: •C onnect with a personal Family Wellness Counselor to support the family. •C omplete a family survey and assessment that identifies areas of success and areas in which the family may wish to improve. Topics explored as a part of the survey include communication, discipline, nutrition and physical activity. •H ave the option of participating in group and individual-level wellness programs specifically designed for local families. •G ain access to behavioral health professionals dedicated to the health and well-being of your family. The service is offered in the Lancaster Community as a part of the commitment of CHI St. Joseph Children’s Health to supporting local families. There is no cost for families to enroll and complete the family survey and assessment.
1.844.837.9285
1929 Lincoln Highway East, Suite 150, Lancaster, PA 17602 717.397.7625
| www.CHIStJosephChildrensHealth.org
About CHI St. Joseph Children’s Health A part of Catholic Health Initiatives, CHI St. Joseph Children’s Health is a community-based organization dedicated to the health and well-being of children and families in the Lancaster Community. The organization works in collaboration with community partners to assure access to appropriate, quality health services and benefits for every child in the Lancaster community. This mission in children’s health includes multiple efforts, programs and services committed to improving the health of children and families throughout the Lancaster community. To learn more about CHI St. Joseph Children’s Health, visit www.CHIstjosephchildrenshealth.org.
Unlimited Potential
For more information or to sign up for CHI St. Joseph Children’s Health Family Wellness Program complete and return the attached request for services form (on the back of this panel) or call 1.844.837.9285.
Providing Your Child and Family Every Opportunity for Success
ENROLLMENT APPLICATION Please print clearly and use pen when completing the application.
Child’s Name: ________________________________________ Address: _____________________________________________ _____________________________________________________ School: ______________________________________________ Grade: ___________________ Teacher: ___________________ Care Giver 1 Name: ___________________________________
Lives with Child:
❑ Yes
❑ No
Phone: __________________________________ H/O/M
Email: __________________________________________
Primary Family Contact:
❑ Yes
❑ No
Best Time To Contact: AM / PM / Evening (Before 8PM) Care Giver 2 Name: ____________________________________
At CHI St. Joseph Children’s Health we believe that every child is filled with unlimited potential…
Lives with Child:
❑ Yes
❑ No
Phone: __________________________________ H/O/M
Email: __________________________________________
Primary Family Contact:
❑ Yes
❑ No
Best Time To Contact: AM / PM / Evening (Before 8PM)
❑W e are requesting that CHI St. Joseph Children’s Health contact us to enroll and participate in the Family Wellness Program. We understand that we may withdraw our request to participate at any time. A member of the staff at CHI St. Joseph Children’s Health will contact us via phone to begin our enrollment in the program.
__________________________________________________________ Parent / Guardian Signature
___________________
Date
(glue strip for sealing envelope)
City: ____________________________ ZIP Code: __________
(inside of BRM envelope)
and that families – of all forms, types and sizes – are the key to unlocking a child’s potential and allowing it to be shared with the world.
1.844.837.9285
Yet, every child and every family is different.
There is not always a right or a wrong. In reality, much of the time it just is. Children do not come with instruction manuals and families do not have admission standards.
The challenge for all of us is figuring out how we belong, how we grow one another and how we free our potential as children, as caregivers or parents and as families.
1.844.837.9285
CHI St. Joseph Children’s Health is here to help. Our innovative family wellness program, which includes individual, family and community-level activities, works with children and families throughout the Lancaster Community.
Let us continue the journey together.
Our team provides families with support, guidance and encouragement as you travel your child’s and your family’s unique path to health, wellness and happiness.
1.844.837.9285
All families enrolled in the Family Wellness Program: •C onnect with a personal Family Wellness Counselor to support the family. •C omplete a family survey and assessment that identifies areas of success and areas in which the family may wish to improve. Topics explored as a part of the survey include communication, discipline, nutrition and physical activity. •H ave the option of participating in group and individual-level wellness programs specifically designed for local families. •G ain access to behavioral health professionals dedicated to the health and well-being of your family. The service is offered in the Lancaster Community as a part of the commitment of CHI St. Joseph Children’s Health to supporting local families. There is no cost for families to enroll and complete the family survey and assessment.
1.844.837.9285
1929 Lincoln Highway East, Suite 150, Lancaster, PA 17602 717.397.7625
| www.CHIStJosephChildrensHealth.org
About CHI St. Joseph Children’s Health A part of Catholic Health Initiatives, CHI St. Joseph Children’s Health is a community-based organization dedicated to the health and well-being of children and families in the Lancaster Community. The organization works in collaboration with community partners to assure access to appropriate, quality health services and benefits for every child in the Lancaster community. This mission in children’s health includes multiple efforts, programs and services committed to improving the health of children and families throughout the Lancaster community. To learn more about CHI St. Joseph Children’s Health, visit www.CHIstjosephchildrenshealth.org.
