ErinoakKids - Day Respite Referral Form

callContact Us eventEvent Calendar loginErinoakKids Connect Login searchSearch cloud_syncSmartStart Hub g_translateTranslate this site

All Services

Get Involved

Careers & Volunteering

About

Donate

search menu

All Services arrow_forward

Accessing Services Intake Services and Referrals SmartStart Hub Resources

Services Assistive Device Resource Service Autism Services Blind-Low Vision Early Intervention Program Early Childhood Resource Services Infant Hearing Program Medical Clinic and Specialty Services Occupational Therapy Physiotherapy Preschool Speech and Language Recreation Therapy School Based Rehabilitation Services (SBRS)

Family Supports Coordinated Service Planning Family Support Fund Fetal Alcohol Spectrum Disorder Respite Service Navigation Social Work Services Special Services at Home Transitions Services Workshops

Programs Independent Living Program Summer Therapeutic Programs

Get Involved arrow_forward

Family Engagement Workshops and Upcoming Events Peer Support Volunteer Participate in Research Share Your Story ErinoakKids Connect Your Feedback

Participate in Research Help Computers Learn "S" Listening to the Intersectional Lived Experiences of Youth with Disabilities Make The Connection MPOC 2.0: Measure of Processes of Care Parent Experiences in the Infant Hearing Program Studying brain networks in children with ASD The Family Engagement in Research Course Virtual Care Study

Support Us Stories of Impact Ways to Give Fundraising Events Celebrating our Supporters Fundraising Privacy Policy Contact the Fundraising Team

Careers & Volunteering arrow_forward

Careers Job Opportunities Why Work Here

Volunteering Volunteer Application/Login

callContact Us eventEvent Calendar loginErinoakKids Connect Login searchSearch cloud_syncSmartStart Hub g_translateTranslate this site

Donate

Forms chevron_right

Home / Day Respite Referral Form

Please upload the Day Respite Referral Form*

Please select a file

Maximum 8 MB file size

Name of Person Submitting the Form(s)*

Contact Number for Person Submitting the Form(s)*

Contact Email for Person Submitting the Form(s)*

Please enter any additional information you would like us to be aware of:

Consent*

I Consent

This information is being submitted with the knowledge and consent of the parents/legal guardians. By providing the contact information with the form(s), you consent to receiving information about new service offerings, fundraising initiatives and free events offered at ErinoakKids by email, post, SMS/Text and other electronic means. ErinoakKids will always treat your personal details with the utmost care and will not share or sell your personal information. You may unsubscribe from receiving communications from ErinoakKids at any time. We are committed to keeping your information safe and confidential. We follow the rules set out in law about collecting, using and disclosing your personal information. For more information, please review our privacy policies publicly posted at https://www.erinoakkids.ca/privacy.