Adult Recreation Become a MemberCliAdmin2022-06-16T08:44:19-05:00

Interested in becoming a member? Tell us more about you:

Admission Criteria:

Resident of St. Charles County
Documented diagnosis of a developmental disability
At least 18 years of age
Must have a Department of Mental Health (DMH) ID number
Free from severe behaviors that are dangerous to self or others
Able to participate in events with non-medical personnel

Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Date of Birth*
MM slash DD slash YYYY
Gender:
Is the individual their own guardian?*
- Yes
- No
Guardian Name*
Disability
Case Manager's Name
Case Manager is with:
- DDRB
- Regional Center
- Not Applicable/None
Person making member request:*
Phone #:*
Email
How did you hear about Community Living?