Referral Form Please enable JavaScript in your browser to complete this form.Who are you referring?My ChildA child of whom I have custodyI am from an agency + working with a childYour Name *FirstLastYour Email *Referral Agency (if applicable)Mental Health Agency with whom my family is workingYouth Name *FirstLastYouth Date of BirthLegal Guardian Name *FirstLastLegal Guardian Phone NumberRelationship of Legal Guardian to YouthYouth AddressAddress Line 2 CityState / Province / RegionZIP / Postal Code *Youth County/RegionDoes the Youth have Medicaid?YESNOIf yes, enter their Medicaid number:The youth's legal guardian will be contacted directly regarding services. Please provide the best contact number above.Submit Send Us a Message Please enable JavaScript in your browser to complete this form.Name *Message *MessageSend Message Main Office: +1 330-630-5600 k.reitman@sheltercareinc.org Hours of Operations:M-TH: 8:30 a.m. to 4:30 p.m. | F: 8:30 a.m. to 3:00 p.m.For crisis situations contact the 24 hour telephone hotline available at the Safe Landing Youth Shelter. Call our 24/7 Crisis Hotline anytime 330-784-7200 Safe Landing +1 330-784-7200 D.Tousely@sheltercareinc.org The Highlands +1 330-633-9474 m.dotterer@sheltercareinc.org Street Outreach 1 234-571-2807 n.woodley@sheltercarinc.org Respite & Shelter Home +1 330-630-5600 j.h.roper@sheltercareinc.org