Rapid Respite Relief Registration Form

Please note: Your honest answers to the following questions are strongly encouraged. Your child or children will not be declined from participating in this program due to your responses. We welcome all children, no matter what end of the spectrum they are on. They are all Au-Tastic in our eyes and we look forward to serving them.

The waivers MUST BE signed and submitted either electronically with this form or in-person before dropping off your children.

  • Date Format: MM slash DD slash YYYY
  • A sensory room/quiet room will be available.
  • DATSMOM Photo Consent Form
    DATSMOM COVID-19 Waiver
    DATSMOM Eastdale Respite Waiver
    Drop files here or
    • D.A.T.S.M.O.M. will not administer any prescription medication.

      D.A.T.S.M.O.M. suggest you bring a change of clothing for your children. Please clearly label all bags, electronic devices or toys your child may bring to the respite care event. D.A.T.S.M.O.M. or the respite care host site will not be responsible for any lost, damaged or stolen personal items you or your children bring to the respite care event. Cots will be available for napping, should some children need and/or request a nap. Pillows and blankets will not be available. You are welcome to bring pillows and blankets for your child or children.