C2C Respite Network participation

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Please answer a few questions below to let us know that you are interested in being a part of the Caregiver-to-Caregiver Respite Network and would like to be notified when we are ready to launch this new initiative for caregivers of children and youth with special health needs.

The Federation for Children with Special Needs is funded by grants which require us to collect data. Our registration is confidential and used to ensure we are supporting all communities. We do not share personal information nor do we sell to third parties.

Email *

Your first name *

Your last name *

Best phone number to reach you *

Do you give us permission to contact you via text? *

Yes

The number above is a land line

Other:

Alternate phone number

What town are you located in?

Your primary language *

Other languages

I am a professional working with families of children and youth with special health needs who would like to receive information about Caregiver-to-Caregiver Respite Network that I can share with families I serve. *

Yes

Other:

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