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OUR PROGRAM
- APPLY
OUR IMPACT
OUR TEAM
FOLLOW US
CONTACT
DONATE

ONE-YEAR PROGRAM
APPLICATION FOR ADMISSION

The River’s Edge Ranch Drug and Alcohol Recovery Program is costs $500.00 per month, per rancher due on or before the first of every month.
Financial assistance for monthly fees may be available upon leadership approval and are considered on a case by case basis.

* Indicates required field

Your Name and Address *

Line 1

Line 2

City

State

Zip Code

Country

Your Phone Number *

Your Email *

Parent's Name and Address *

Line 1

Line 2

City

State

Zip Code

Country

This information is optional

Parent's Phone Number *

This information is optional

How did you hear about The Ranch? *

Internet Search Advertisement Friend Other

If Other, please specify: *

What is your age? *

18 19-25 26-35 36-50 Over 50

What is your household income? *

Less than $10,000 $10,001 - $25,000 $25,001 - $40,000 $40,001 - $70,000 $70,001 - $100,000 Greater than $100,000

Other income? *

Disability SSI Foodstamps None

What type of insurance do you have? *

Medi-Cal/Medicare Your own insurance None

Why do you want to be a Rancher? *

Are you currently using drugs or alcohol? (describe) *

Have you ever been convicted of a crime? (describe) *

Submit

ONE-YEAR PROGRAM​APPLICATION FOR ADMISSION

ONE-YEAR PROGRAM
APPLICATION FOR ADMISSION