APEXTeen Application

Please fill out the form below.

Teen Applicant Information

Teen Activities

Teen Family Information

please describe

Teen Applicant History

Overdose Lifeline has been providing services for youth and families experiencing issues such as addiction, poverty, abuse and mental health for over a decade. We recognize the following questions may be sensitive information to share, but this will help us plan and prepare a program that will benefit all youth. In the event of current abuse of any type, Overdose Lifeline staff are mandated reporters.

Mental Health


Foster Care/Kinship Care


Program Interest

Parent/Guardian Contact Information

Emergency Contacts

Please list two people other than you to contact in case of an emergency at the program.

Additional Teen Information


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Aaron’s Place needs people like you to help as mentors, camp facilitators, and volunteers.

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