Application Form for Admission to Youth Program

To be considered for admission to our Youth residential treatment program, the following form must be completed:

NOTE: To view this form, you must have Adobe Reader installed.

Please forward the completed form as follows:

Female Applicants:

Female Youth Services
Behavioural Health Foundation
Box 250, 35B ave de la Digue
St. Norbert, MB R3V 1L6

Fax: (204) 275-2099

Male Applicants:

Male Youth Services
Behavioural Health Foundation
1147 Breezy Point Road
Selkirk , MB R1A 2A7

Fax: (204) 482-9717

If you require assistance in completing these forms, or have questions concerning admission to our Youth treatment programs, please contact the Behavioural Health Foundation Youth Services through one of the following methods:

Intake Enquiries:

Kristel Whitfield, Placement Coordinator