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Respite Intake INformation

Current Accommodations:

If possible please bring your ISP to the next Respite event so we can best meet our participants’ needs.
(if so this can be used reimburse you for our Respite program)

Tips for Working With Me:

Sensory Checklist:

Please list the participant's sensory preferences on a scale from 1-5: 1 being avoids or dislikes 3 being neutral 5 being enjoys or seeks out

Touch:

Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1

Auditory/Listening

Selected Value: 1
Selected Value: 1

Vision:

Selected Value: 1
Selected Value: 1
Selected Value: 1
Selected Value: 1

Taste&Smell

Selected Value: 1
Selected Value: 1

Other Information