top of page

About
- Statistics
- Resident Stories
Program
Clubhouse
- Membership Inquiry Form
Contact

Clubhouse
Membership

Features

Broadway STARS Clubhouse Membership Inquiry

Fill out the form below and we'll reach out to you with more information about joining.

Referred By...*

Phone*

Date*

Referral Agency*

Referral Agency Comments*

Applicant Name*

Applicant Date of Birth*

Month

Day

Year

Age (must be at least 18 years of age)*

Multi-line address

Country/Region*

Address*

Address - line 2

City*

Zip / Postal code*

Phone*

Alternate Phone

Living Situation*

Homeless

Group Home

Independent

Living with Relatives

Employed*

Yes

If yes, where?

How long?

Annual Income Amount

Method of Transportation*

Mental Health Diagnosis*

Reason for ReferraI (check alI that apply)*

Socialization Skills

Employment Support

Improve Cognitive/Concentration Skills

Manage Symptoms that Interfere with Education or Employment

Interpersonal Skills

Prevent Isolation

Prevent Psychiatric Hospitalization

Improve Self-Confidence/Motivation

Independent Living Support

Other

Is there a history of substance abuse, violent behavior or suicide attempts? Please explain:*

Mental Health Diagnosis documentation is required for all Broadway STARS Clubhouse members. Please upload documentation.**

If you have any questions on the above form fields, please contact clubhouse@broadwavyrecovervyservices.org.

Get In Touch
1-855-292-9778
info@broadwayrecoveryservices.org

Get Broadway in your inbox!

Stay connected to the heart of our mission by signing up for our monthly newsletter, where we share powerful stories of resilience, recovery, and community impact. Join us in this journey—get updates, inspiring success stories, and ways you can help make a difference.

©2025 Broadway Recovery Services (BRS) is a 501(c)(3) non-profit organization
725 Boardman-Canfield Rd Unit C4, Boardman, OH 44512

Privacy Policy
SITE BY MCCONNELL MARKETING

bottom of page

Clubhouse Membership