Vista Hill Programs - Bridges Early Intervention Registration Form

Instructions: Please fill in the information and select the class and location you want to attend. You may contact the program for more details regarding fees and scheduled group dates.

You may submit your registration form online or contact our office at: 858.514.5101 or fax: 858.874.8149.

Personal Information
Client Name
Date of Birth
Parent / Guardian Name
Email Address
Phone Number
Address
City
State
Zip Code
Referring Agency
Contact Number
Case Number

Class List
	Anti-Theft / Shoplifting Education Total time 8 hours.
	Tobacco Education Total time 8 hours.
	Anti-Graffiti Education Total time 10 hours.
	Anger Management Total time 8 hours.
	Attendance / Truancy Total time 6 hours.
	Healthy Behaviors Early Invervention For experimental users. Total time 12 hours.
	Healthy Behaviors - Level 1 Intervention Program. Total time 3 months.
	Healthy Behaviors - Level 2 Case Management Module Drug testing for compliance and referral services. Weekly hour requirement varies. Total time 6 months.
	Screening, Assessment & Recommendation Services include a SASSI screening, and an in-depth assessment, and referral. Total time 1 hour .
	Drug Testing Service is a presumptive (qualitative) test. If a quantitative test is required, there is an additional charge.
Location Please check the location you would like to attend.
	Main Campus - Bridges Trailer 2851 Meadowlark Drive, San Diego, CA 92123 Juvenile Court/Probation campus (next to the Girls Rehab building) Drug Testing, Anti-Theft / Shoplifting, Anti-Graffiti Ed. Smoking/Tobacco Ed. & Anger Management
	East County Area ParentCare Family Recovery Center 4990 Williams Ave., La Mesa, CA 91941 Healthy Behavior classes held on Monday & Wednesday evenings at 6:00pm
	North County Area Bridges Service Center 740 Lomas Santa Fe Drive, Ste. 200, Solana Beach, CA 92075 Healthy Behavior classes held on Thursday evenings at 6:30pm
	South Bay Area Stein Education Center 647 E. St., Chula Vista, CA 91910 Healthy Behavior classes held on Tuesday evenings at 6:00pm