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Request Information

Thank you for your interest in our program! 

Edgewood Children's Ranch exists to serve the needs of local families; if you live within one hour of our campus, please fill out the form below, and our Family Care Office will contact you and provide the information you desire.

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender *
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Last Name *
  • Salutation
  • Email Address *
  • Confirm Email Address *
  • Gender *
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • Do you live within one hour of 1451 Edgewood Ranch Rd, Orlando, Fl 32835
    * Yes   No

  • Do you currently have legal custody of the child? Is this shared custody? If not, who does?
    *

  • Admission Question #1: Does your child have violent tendencies or display physical aggression toward others, especially peers or younger children?
    *

  • Screening Question #2:  Has your child ever demonstrated inappropriate sexual behaviors toward younger children? Are they overly sexualized (do they participate in chat rooms, sexting, etc)?
    *

  • Question #3:  Is your child a FREQUENT runaway? If so what does that look like?
    *

  • Question #4:  Does your child have a history of self-harm, suicidal or homicidal ideations? Have they been Baker Acted before? If so, how recently? Can you show paperwork for these visits?
    *

  • Question #5:  Does your child have any clinical diagnoses or special needs? (Note: We do not accept kids with ASD at any level)
    *

  • Question #6:  Does your child have any severe allergies to food or other things? Do they have any food tolerance issues or special dietary needs? (We cannot, provide for special dietary needs including vegan, vegetarian, gluten-free, etc., here at Edgewood)
    *

  • Please tell us why you are considering Edgewood Ranch for your child?
    *
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •