Youth Residential Services Inquiry

We’re glad you’re here!

To make a referral, please complete the form below and we will be in touch with you soon to continue the application process. If you are a parent and not sure if your child needs services, please call us at 605-221-2421.

Client Information:

First & Last Name

Age

Gender

Desired Placement Date

Please send referral to appropriate center(s).

Canyon Hills, Spearfish
Summit Oaks, Sioux Falls
Both

Referred By:

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Your Name

Organization

Relationship To The Child

Phone Number

Fax Number

Email Address

Tell us more about yourself and how we can help:

What else would you like us to know?

How would you like us to contact you?

Email
Phone

Residential Services Referral

We’re glad you’re here!

Client Information:

Referred By: