• Reach Out to Connect Kids (ROCK) Referral Form

    This form is not monitored 24/7. We adhere to strict confidentiality. However, if there is a safety risk concern, we are mandated to report to the appropriate authority.

  • Referral Source Info

  • Information Regarding this Child
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  • After your ROCK referral is received, you will be contacted by one of the infant/early childhood consultants who will explore the current needs and concerns, and discuss the next steps.
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