Respitality Application

Respitality Application is Now Closed

Please note that if you are selected for a Respitality Experience, you will be asked to provide a copy of your family member’s Psychological Assessment/Psycho-educational Assessment indicating a diagnosis of an Intellectual Disability or Global Developmental Delay, if age 5 and under. Unfortunately, if you are not able to provide this information, you will not meet the eligibility requirements to receive the Respitality Experience.

Please complete all sections of the application. One application per household will be considered.

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Name
Preferred Method of Contact:
Do you wish to identify as an Indigenous person?
Are you a Military Family?
I declare that:
Age of Person Receiving Care
Please indicate which document(s) you will be providing if selected for Respitality:
Please select the region(s) you would prefer to enjoy your Respitality Experience (you may choose more than 1)
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Please indicate if you have any potential barriers that would impede your ability to accept a Respitality Experience
How Did You Hear About Respitality?
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