Child Application | Crown Valley Youth Ranch

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Mentor | Empower | Hope

Child App

Child's Name*
First Last
Parent's Name*
First Last
Email*
Date
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (if different from physical address)
Street Address Address Line 2 City State ZIP Code
Age of child
Date of birth
Gender
- Male
- Female
What category does your child fall under?
- Biological child
- Adopted child
- Foster child
- Other
What time/day(s) are they in school?
Grade in school
What school is your child enrolled in?
How did you hear about Crown Valley Youth Ranch?
Describe your child in a few sentences
Rate your child's social interaction on a scale of 1 to 5 (1 being the lowest and 5 the highest)
How creative is your child on a scale of 1 to 5
How well does your child do with animal interaction on a scale of 1 to 5
How outgoing is your child on a scale of 1 to 5
How physically active is your child on a scale of 1 to 5
How attentive is your child on a scale of 1 to 5
How acedmic is your child on a scale of 1 to 5
How mechanical is your child on a scale of 1 to 5
How honest is your child on a scale of 1 to 5
How angry is your child on a scale of 1 to 5
How content is your child on a scale of 1 to 5
How happy is your child on a scale of 1 to 5
How is your child's self-esteem on a scale of 1 to 5
How often does your child struggle with depression on a scale of 1 to 5
How often does your child struggle with anxiety on a scale of 1 to 5
How well does your child complete a given task on a scale of 1 to 5
How often does your child succumb to peer pressure on a scale of 1 to 5
How well does your child respond to authority on a scale of 1 to 5
How well does your child work in teams on a scale of 1 to 5
How responsible is your child on a scale of 1 to 5
How well does your child do with chores on a scale of 1 to 5
How motivated is your child on a scale of 1 to 5
How well does your child pay attention to detail on a scale of 1 to 5
How hardworking is your child on a scale of 1 to 5
How intimidated by others is your child on a scale of 1 to 5
Which programs would your child be interested in
- Equine (horses)
- Crafting (handcrafts, woodworking)
- Horticutlure (gardening)
- Small Animals
Describe why you feel your child would benefit from CVYR
How does your child interact with family?
Tell us about your family and home dynamic
What is your child's/family's religious background?
If your child has siblings, please list their names and ages below
If parents are separated/divorced, what are the living arrangments of your child?

CROWN VALLEY YOUTH RANCH @ 2017 | PRIVACY POLICY

Home
About
- What We Do
- Our Staff
- Our Board
- Photos
- FAQs
Join Us
Horse Rescue
- Why Horse Rescue?
Blogs & News
- Newsletters
- CVYR Blog
Contact Us
- The Ranch Hand Page

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