Respite FamilyHome Application/Preference Form

Do you have a willingness to open your home every now and then? Officially, Respite support provides individuals and their families with short breaks. But really, it’s about building a relationship with someone new and having experiences together that are truly fulfilling for everyone. 

Extend-A-Family is an equal opportunities employer. We are committed to ensuring that people with disabilities have the same opportunity of access to employment.

  • Skills/Experience

  • Availability

  • Date Format: MM slash DD slash YYYY
  • For providing support in your own home:

  • If yes, please complete the following: