Embracing Arms - a young ladies group home

Untitled Document

Embracing Arms, Inc.
“Embracing Our Children For a Better Tomorrow”

Program Referral and Intake Form

Referral Date: Nov 26, 2025

The purpose of Embracing Arms, Inc. is to provide a safe, secure and nurturing environment for Females between the ages of 12-18 years of age who come in need of out of home placement from the Department of Juvenile Justice and the Department of Family and Children Services. Embracing Arms, Inc. is a structure self help program that includes instruction and guidance in personal life management along with discipline and encouragement.

Name Of Child
Date of Birth:

Parent/Guardian:
Street Address:
City/Town:
State:
Home Phone:	( ) - -
Alternate Phone:	( ) - -
Referral Agency:
Agency Contact:
Agency Phone:	( ) - -
Email Address:
Medicaid or Peachcare # :
Has Psychological been completed?	If yes, upload supporting docs (pdf & word files are accepted) You may also upload a .zip containing more then one document

Embracing Arms, Inc. provides and identifies any services needed to deter the illegal activities of referred youthful offenders and direct their families towards positive life goals. It is Embracing Arms intent to provide services that will meet medical nutritional, educational and psychosocial needs of our residents.