In response to the COVID-19 pandemic, ErinoakKids has made changes to our operations. Please click here for the latest information.
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Respite MFTD and Non MFTD Program Application

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.

(other than parent/guardian - must be aware that they are the alternate contact)
Select all that apply
Consent required before each camp for swimming. All persons are 1:1 with staff in the pool.
We require documentation of your family member’s immunizations; please bring with you on your first visit or fax (prior to first visit) to 905-794-0547. You may also upload this below.
Medication directives will be taken by the nurse and listed on the Medication Administration Form.
Please provide details for any concerns or procedures that are relevant.
Specify amount and delivery method (we require the medical order for the oxygen parameters)
I wish my child to attend ErinoakKids Respite Centre. I have given ErinoakKids the information that will help staff to assist my child. I understand every effort will be made to contact parents/guardian in the case of an emergency. I authorize staff to seek medical care if necessary.