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Mercy House

Get Help Now — We’re Here for You

You don’t have to do this alone. We’re waiting on you and ready to help. Call us right now, or fill out the form below and our intake team will get back to you.

Confidential · Free to call · Faith-based, never preachy

Confidential Intake Application

Mercy House Adult Teen Challenge

Step 1 of 4 — 25% complete

✓ Low cost program — Financial help available

Need a shorter form?

If the full form is too long or difficult, you can submit a condensed version with just the essential information. Our staff will follow up by phone to collect additional details.

Program Selection
Personal Information — Confidential

Used for enrollment records only

Contact Person (optional)

Someone we can contact about your application status