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Participant

Thank you for taking the time to fill out this form. Please complete it before February 1st. We will get back to you within the week. 

We are hosting a FREE 2-hour respite for parents of individuals with special needs! The theme will be Valentine's Day. We will also have something for siblings from birth - 13 years old.

 

We know that respite is a huge need for our families. We will be providing respite events 

COVID-19: We want to ensure the health and safety of everyone with the ongoing concerns of COVID-19. We ask that if you or someone you have been in contact with has tested positive that you please stay home. We will have extensive cleaning between each respite event.

Paperwork: All participants must fill out and return a Plan of Care and Consent form by February 1st in order to attend February's event.  Plan of Care and Consent forms can be found by clicking the button.

 

 

PLEASE NOTE: Your individual(s) with special needs must be signed up in order for their siblings to attend! 

We look forward to serving your family through this event!

Any questions please email hward@mofphc.org

LOCATION

130 Ed Edmundson Mount Olive NC 28365

Thank you for submitting your form. Please note that because you submitted a form does not mean you have been promised a spot. We want to make sure you have the best experience possible. We will contact you shortly with confirmation. 

SIGN UP TODAY