Camp Fire Respite Care
To help assist those in need, Family First is offering to provide respite care to families of children with a developmental disability who have been effected by the Camp fire, free of charge. Please fill out this questionnaire if you or someone you know is seeking respite care for a child diagnosed with a developmental disability who has been displaced or severely impacted by the wildfire in Butte county.;
Email address *
Your name *
Your answer
Phone number
Your answer
Are you a volunteer, staff member or Director of an organization providing shelter/aid/assistance to fire victims?
If "Yes" please list the name and contact information of your organization below
Your answer
Relation to individual requiring respite care
Age of individual requiring respite care
What developmental disabilities does the individual have?
List any known maladaptive behaviors
Last known city of residence
Your answer
Current location (county)
Current location (city)
Your answer
Location type
Please provide a brief description of circumstances relating to the need for respite care
Your answer
Who should we contact to arrange respite services?
If "Other" please provide the name, relation and contact information of the individual we should contact
Your answer
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