Care Team Request Form

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Thank you for your interest in the Michiana Care Team program at Michiana Family Center! The information you provide below will help us to better match you with a group of volunteers.

First Name *

Last Name *

Phone Number *

Email *

County of residence *

Berrien County, Michigan

Cass County, Michigan

Elkhart County, Indiana

St. Joseph County, Indiana

St. Joseph County, Michigan

Name and Phone Number of Social Worker (if applicable)

What are two ways in which a Care Team could provide support? (Choose at least 2 but as many as would be helpful to you!) *

Celebrate Birthday(s) of the month

Meals provided

Small home repairs

Assembly of new items like furniture or hanging pictures

Reading books to kids

Help with student's homework

Field trips for kids in the home

Gas cards for helping with appointments

Mentoring for the adults in the home (example; financial planning, parenting advice)

Babysitting help

Restaurant/delivery gift cards

Activity gift cards

Movie gift cards

Other:

Required

What are some of the favorite activities of children in your home?

What are some of the favorite activities of the adults in your home?

What are some of the favorite activities for your family to do together?

Are there any other details that might be helpful for a Care Team to know?

Are there any specific details about your home you'd like MFC and/or volunteers to know about?

Submit

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This form was created inside of Michiana Family Center.