Student Referral Form

/Student Referral Form
Student Referral Form2017-01-18T12:00:18+00:00

Wears Valley Ranch and St. Andrew’s School exist to help children who have a problem in the home that is not primarily the child’s fault.  To qualify for admission, the child must be in grades K-12 at the time of admission, must be willing to be considered, and must not pose a threat to others in our care.

Please complete this short form to let us know about a child or family who may be interested in admission.

Child #1 Name (required)

Age (required)

Gender (required)
MaleFemale

Child #2 Name

Age

Gender
MaleFemaleNo 2nd Child

Child #3 Name

Age

Gender
MaleFemaleNo 3rd Child

Guardian Name(s)

Family's Location (City, State)

Brief description of the problem in the home (required)

Your relationship to this family (friend, relative, teacher, pastor, neighbor, etc.) (required)

Your Name (required)

Your Phone # [xxx-xxx-xxxx] (required)

Your Email (required)

Best Time To Contact You?

Best Method To Contact You?

How Did You Hear About The Ranch?

Wears Valley Ranch Christian Children’s Home and Boarding School Overview

Wears Valley Ranch provides Christian children's homes, a Christian boarding school, and Biblical counseling to children in crisis situations. Our vision is to see each child inspired to follow Christ, healed from the past, and equipped to reach their full potential.