Respite Support Request Respite Program: Tell us about your kid! County(Required)BondFranklinGreeneHamiltonJacksonJeffersonJerseyJohnsonMadisonMonroeSalineSt. ClairWayneWilliamsonFoster Family Name (first & last)(Required)City of Residence(Required)Church Affiliation, if applicablePlease provide the following information about your kids so we can try to make the best match for your family!Please list each kid's name, gender, and age (only the ones you are seeking respite for).(Required)Tell us about your kid! For each kid you are seeking respite for, please describe their personality, likes and dislikes!(Required)For each kid, please describe their hobbies & interests. What would they have fun doing with a respite volunteer?(Required)For each kid, please list any physical or mental health conditions that need to be considered.(Required)Are there any "house rules" that set your kid up for success that we could honor for you in the respite relationship?(Required)Examples: screen time use, food or drinks that are off limits, exposure to certain things or places, etc. Are there any special considerations or things about their story that we need to know in order to make the best match for you?(Required)Briefly describe what kind of respite would best support your family (daytime, evenings, weekends, school holidays, summer, etc.)(Required)Anything else we should know?(Required)It the kiddo(s) in foster care still, please provide the case worker's name and email or write N/A if adopted(Required)Please read and respond.While our leadership is a community of believers following Jesus, all are welcome to be a part of the solution. We serve all people, without regard to race, national origin, sexual orientation, disability, age, or any other factor. We also seek to work alongside people of all walks of life who share our vision to change the culture of foster care so every child experiences healing. Within the Respite Program, we do our best to make a good match between families and respite volunteers. We are hopeful that good relationships can still be formed even if everyone does not share the same values, but we acknowledge that there may be times when respite matches may not work for a variety of reasons. If you, as a parent or a volunteer, have concerns with the match at any point, please reach out to Restore staff.(Required) I agree As a Restore Network family, I acknowledge that the Restore Network works closely with child welfare agencies across the state in a variety of ways, including, but not limited to communication regarding respite matches set up through The Restore Network. I consent to the Restore Network staff working together with our agencies throughout placement, to ensure adequate supports for our family and the safety and care of the child(ren) placed with us for as long as they reside in our home as a foster child(ren).(Required) I consent Parent NamePlease type your nameDate MM slash DD slash YYYY Δ
