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Program Level Participation

Parents, YBTDP offers three levels of program participation.  Please place a check mark next to the program level that best meets your family’s needs. Be sure to sign and date this document.
Program Level Options (Check only 1 option)


__________ Level  I (19 hrs of face-to-face contact). Youth take part in two consecutive weekends of programming (Sat. 9 am – 1 pm & Sun. 9 am – 1 pm). This totals 16 hours of contact (including 2 meals). Parents take part in 3 hours of parent education (Saturdays

10 am-11:30 am). Level I Cost: $240.00


__________ Level  II (24 hrs of face-to-face contact). In addition to taking part in Level I programming, a total of 5 hours of face-to-face home/community-based visits take

place. Level II Cost: $490.00


__________ Level  III (30 hrs of face-to-face contact). This level features participation in Level I and Level II programming, along with 6 hours of individual/family counseling sessions.  Level III Cost: $910.00


Total Amount: ___________________




_____________________________________________        _______________________

Parent’s Signature                                                                              Date


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