CARE Respite Program Registration
If you are interested in learning more and/or registering a person in your care for the CARE Respite Program, please complete this form. 

Please note Individuals in AFC or a Group Home are NOT eligible. The program serves loved ones that currently reside at home. 
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Email *
Individual's name
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Individual's age at time of application
 *
Individual's gender identity
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Ethnicity and Race (mark all that apply) *
Does the Individual reside in a group home or do they live at home with you?
 *
Required
GROW's respite program service criteria is designed for individuals with a mild to moderate intellectual, developmental or physical disability. 

In order to maintain a quality program, sessions are designed to accommodate specific needs of participants through staffing ratios, programming, and activity goals. With our unique environment and seasonal staff, our goal is to accommodate as many participants as we can safely accommodate.

Unfortunately we are unable to serve participants at this time who demonstrate one or more of the following:

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We may likely expand our inclusion criteria to allow those who need toileting help and with limited behavior and can add your loved one to the list for future cycles once our seasonal weekend staff is trained. We also reserve the right to dismiss an individual at program based on illness, injury, or safety risk to themselves or others

Does the individual attend a Day Program?

If your loved one attends a different program other than GROW or are not participating in any program, we require a copy of their DDS cover sheet or service coordinator information. which can be emailed to tgreen@grow-associates.org
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If Yes, please indicate the name of the program or specify the School name
Does the Individual have any Allergies?
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Please list the allergies your loved one has.

We are also offering Life Skills and Peer Mentoring services (some examples include: folding clothes, making sandwiches or snacks, communications, etc.)

What does your individual need help with?

Caregiver's name
 *
Caregiver's contact information: Phone Number
 *
Indicate which respite Cycle(s) you are interested in.
Please note that Cycles 2 through 6 are comprised of 10 sessions, every other Saturday and Sunday. It's likely more than one Cycle will be available to you, but depending on the demand, can't be guaranteed.
Individual Days - Drop In Options  
If your loved one can't attend the entire cycle(s), please review the schedule using the link below, and then indicate which weekends you are interested in. Priority is given to people committing to full Cycles, but there will be space for drop-ins. 

https://docs.google.com/document/d/1kqVikG1NO7TXYhBlzQf74V0CqR1YyINNEhAaQN0QiOk/edit?usp=sharing
Does your loved one need transportation or will you drop off and pick up? 
We will provide lunch or does your loved one prefer a home lunch?
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We will host an average of 2 parent/guardian support groups during each cycle. They are not mandatory. Schedules will be provided at a later time frame.

Would you be able to participate?
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