Hope Respite Care
Caregiving is a demanding job. As a caregiver, you need occasional breaks so you can tend to your own needs and the needs of other family members. Let Hope Respite Care support you.
Hope’s respite program can provide short-term relief for a few hours, a day, a weekend, or sometimes longer. While respite care is not suitable for ongoing childcare or school, Hope can provide a way to support families who take care of their loved ones at home.
Below you will find our respite application that you can print and fill out or complete online.
This service is of no cost to you, but candidates for respite must be thoroughly reviewed and approved to ensure appropriate care during your child’s stay. Our top priority is safety for your child and the children we already serve. We want your respite time to be a time in which you can feel at peace and trust that your child is well cared for. In order to gain that assurance, our application must be completed thoroughly and candidly. Hope is a highly structured place with great resources; however, no one likes surprises. We will ask questions. We will search for clarity. We will be thorough. We will be taking care of your most precious possession and we don’t take this responsibility lightly.
Please complete this application in its entirety. Any incomplete applications will be returned. If you have any questions, reach out to Amanda Brott firstname.lastname@example.org or Rebecca Murphy at email@example.com
Please include all documents as outlined below; without these documents, your application will be incomplete and cannot be processed. Email documents to firstname.lastname@example.org if filling out the online form.
- Complete Application
- Physician’s Health Form (signed by physician)
- HIPAA Policy and Procedure
- Current IEP
- Behavior Plan, Seizure Protocol, Allergen Protocol (if applicable)
- Full List of Medication Including Dosage, Time Administered, and How Administered
Please fill out the form and submit via mail to Amanda Brott at 15 E. Hazel Dell Lane, Springfield, IL 62712 or fax to 217-529-8234 or scan and email to email@example.com.