Respite Care for North Central Montana
Peace Place provides respite, resources and support to parents of children with special needs. We would like to grow to serve more families in rural areas. This survey is completely confidential - it is for the sole purpose of evaluating what kinds of services Peace Place might be able to offer to families who do NOT live in Cascade County. (Visit www.peaceplacegf.com to find out what we do now.) Feel free to share it with any parents of special needs children in the local North Central Montana area. Questions? Call Kristen McGuire at Peace Place, 406-590-4925, or email kristen@peaceplacegf.com.
Email address *
Does your family use respite care already?
What town do you live in? If you do not live in a town, which town in Montana is closest to your home?
Your answer
Which forms of respite are most attractive to your family? (check all that you would use)
If Peace Place were to expand the ages of children served, would any of your other children qualify? (Peace Place currently serves only children ages 0 - 12.)
Yes, also would qualify
No, but we would be interested in simultaneous care
No, not applicable
Ages 0 to 5
Ages 6 - 11
Ages 12 - 18
This list provides other program options for Peace Place. Check all you are interested in.
Do you have any feedback for us? Tell us more about resources in your community that you need.
Your answer
May we add your email to our newsletter list so you will know when we add services and locations to our Peace Place family.
Submit
Never submit passwords through Google Forms.
This form was created inside of Peace Place. Report Abuse