RESPITE PROGRAM FORMS

Now that you are a part of the Respite program, there are some forms that need to be filled out, and information that needs to be updated on an annual basis. We are now accepting all of our forms ONLINE using a service called Formsite. Read the instructions below and the form requirements before completing each form.

INSTRUCTIONS

For each form, the first time you complete it, you will need to create a username and password by filling in left-hand side of the sign-up form (see image, green).

By creating an account this way, you are able to save your progress and sign in to the form using the right hand side (see image, pink), at a later point in time to complete your submission, or sign in at a later point in time to make changes and update your results.

OUR RECOMMENDATIONS

1. Save this webpage to your bookmarks bar for future reference.

2. When choosing a username, use the beginning of your email, to make it easy to remember. For example, email is john.smith1@gmail.com -> username would be john.smith1

3. For ease, use the same username and password for each form you complete with us and write this information down somewhere, as you will need to refer to it over the years.

COMPLETE THE FOLLOWING FORMS

If you have any trouble, please contact Christa at christa@redroofretreat.com.

RENEWAL FORM

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardians/placing agency must fill out this form to ensure all information is up to date.

Annual Renewal Form

LETTER TO DECLINE MEETING

Frequency: ANNUAL

Required: NO

Do you require a meeting with Christa, the programs coordinator to review and discuss your Renewal Form submission?

If not, please fill out this form:

Letter to Decline Meeting Form

PLAN OF CARE

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardian/placing agency must fill out this form to ensure information regarding the child's care is up to date.

Plan of Care Form

SERVICE AGREEMENT

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardians/placing agency must fill out this form agreeing to the terms of the COVID service agreement for the year.

COVID Service Agreement Form

AUTHORIZATION FOR MEDICAL TREATMENT

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardians/placing agency must fill out this form authorizing Red Rood Retreat to administer medical treatment in the event of an emergency for the year.

Authorization for Medical Treatment Form

CONSENT TO USE OF PSYCHOTROPIC DRUGS

Frequency: ANNUAL

Required: NO

Every year, the admitted child's parents/guardian/placing agency must fill out this form to consent to the administration of psychotropic drugs by Red Roof Retreat staff as needed.

Consent to Use of Psychotropic Drugs

CONSENT TO ADMISSION

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardians/placing agency must fill out this form consenting to the child's admission at Red Rood Retreat for the year.

Consent to Admission Form

CONSENT TO VIDEOTAPING AND PICTURES

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardian/placing agency must fill out this form to consent or deny consent to the potential media taking for promotional use for the year.

Consent to Media Form

CONSENT TO VIDEOTAPING AND PICTURES

Frequency: ANNUAL

Required: YES

Every year, the admitted child's parents/guardian/placing agency must fill out this form to consent or deny consent to the potential media taking for promotional use for the year.

Wagon Ride Waiver

Respite: Service