Inpatient Admission Application

Please complete the form below. We will contact you within one working day of receiving your application.

 

Click here for a printable, PDF version of this application

 

Step 1 of 7

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  • Child's Information

    Please provide as much information as possible. Incomplete applications cause delays in processing.
  • Please select gender most closely matched to client's identity for placement purposes
  • Form Submitter's Information

  • Select one

Daybreak Youth Services

Daybreak has been successfully treating teens for drug and alcohol addiction since 1978. We are committed to serving teens and their families, and have become an innovative leader in the youth drug and alcohol treatment field. We operate outpatient and inpatient treatment programs in Eastern and Western Washington. Daybreak serves teens from around the Northwest. Together, Daybreak’s programs serve nearly 2,000 adolescents each year.

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Locations & Directions 1-888-454-5506