Respite Registration Form

Spots are limited.  Children must be 2 years old and older.  A maximum of 2 spots per family, per event is available.  Parents must be in attendance at the meeting to use the childcare.

Additionally, you must fill out 1 form for each child you register for respite care. Your reservation will not be considered valid until this is complete. Please give us the best email and phone number in case we have questions about your information.

 

  • Have you registered this child with the Wake Chapter this year already (September 2013-May 2014) for respite? We should have your form already on file. Use this shorter Registration Form
  • If this is a NEW child for respite reservations, please use the form below

One form must be filled out for each child registered for respite care for each meeting.

Information About the Child Below

M/D/Y