Request for Session/Solicitud de sesiones
If you need a backup Respite Worker for a session please fill out this form so we can start matching your family with a Respite Worker ASAP.

Once the requested session has been filled, you will receive an email confirming the date/time of the session as well as the Respite Worker's information. The Respite Worker will be in contact with you (via text or phone call) to confirm the session as well.

PLEASE NOTE THAT ALL ARCC CENTER STAFF WILL BE ABLE TO SEE ALL RESPONSES ON OUR REQUEST SHEET (Except for questions or concerns at the bottom of this sheet) / FAVOR DE NOTAR QUE TODOS NUESTROS EMPLEADOS TIENEN ACCESSO A SUS SOLICITUDES. ( A exception de preguntas o comentarios al final de esta forma)
Area of service/ Area de servicio (ex. Bay Park, 4's Ranch, Paradise Hills, San Marcos, East Lake etc.) *
Parent/Guardian name Nombre de padres/ Guadian. *
Contact phone number- preferably a cell phone Numero de telefono (Celular de preferencia) *
Client first and last name / /Nombre del cliente *
Client age// Edad *
Date of requested session/ Fecha de servicio *
MM
/
DD
/
YYYY
Start time requested/ Hora de inicio *
Time
:
End time requested / Hora de terminar *
Time
:
Is time and/or date flexible. If so please list date and times that work for you in "notes" field below. / Si el tiempo que necesita es flexible, favor de especificar. *
Have you reached out to your Primary Respite Worker? *
Other notes- ex. female or male only, school pick-up, take to zoo, take to speech, watch two siblings, watch one sibling, I am fine with anytime that weekend at night. REMINDER- all ARCC Center staff will be able to see this. UPDATE-outings are on case by case basis with approval only. At this time ARCC Center is not offering transportation. / Notas ( Ej. llevar a terapia, cuidar a los hermanos tambien, llevar al zologico, cualquier hora funciona)
Do you have any questions or concerns?
Submit
Never submit passwords through Google Forms.
This form was created inside of Autism, Respite, Camp, & Childcare Center, LLC. Report Abuse