Day Program Application

Apply to Join
Midland Kru Day Program

Our Application Process Is Easy

We are so glad you have chosen to apply to our program. Our goal is to help you discover your God given gifts and learn how to use them to reach your goals.
*Filling out this application does not guarantee acceptance.
After you submit your application, one of our staff will be in touch.

Applicant's First Name

Applicant's Last Name

Date of Birth

Phone

Street Address

City

Zip Code

Emergency Contact Name

Emergency Contact Phone

Relationship

Parent/Guardian Phone

Parent/Guardian Email

Is your Associate completely independent during the day?

Yes No

If no, please list abilities, barriers. or limitations that prevent them from attending as an individual that is completely independent.

What Days Would You Like to Attend?
Our hours of operation are Monday- Thursday 9:00am-4:00pm
Monday Tuesday Wednesday Thursday

If you would like to attend, but need financial assistance, we will educate you on how to receive funding. We will also attempt to contact a donor to contribute towards a scholarship.
Please call 470-941-7014 or email debbie@midlandkru.bloomga.org if you are interested in receiving more information or have any questions.
All Applications are reviewed by staff and you will be notified of a decision within two weeks of receipt of your application.

Apply to Join Midland Kru Day Program

Our Application Process Is Easy

Apply to Join
Midland Kru Day Program