Thank you for your interest in the ErinoakKids Respite Program!
Please take the time to complete this form completely and with as much detail as possible. We estimate that it will take about 30 minutes to complete the form. We recognize that this is a big time commitment, but the information you share will help our team make the Respite Program a positive experience for your child. As long as you don't close your browser window, you do not need to complete the entire form in one sitting.
Please complete the application form once you have made your date selections. This form must be completed every 2 years, or more frequently if there are changes to their condition or care plan. Respite staff will contact you if they require additional information prior to your child’s stay. Please bring us a copy of your child’s immunization record on his/her first day at Respite.