Respite Night Application

We care about the safety and well-being of every child. To that end, a completed application is required for each child who would like to participate in a Brides Respite Night event. Our goal during this event is for kids to be safe and have fun; and for caregivers to have a respite with peace of mind that their children are in capable, loving hands. Completing the application helps us be prepared to meet our goals. It will take you about 5-10 minutes to complete. After your application is submitted, someone from our Bridges team will reach out to you during business hours.

In this section, we will ask for information about the adults that belong to the kiddos and emergency contact information.

Please enter a valid phone number.

Name of an adult to contact in case of emergency during the event. Please name someone different than yourself.

Please enter a valid phone number.

Name of an adult to contact in case of emergency during the event. This is someone other than yourself and the first emergency contact.

Please enter a valid phone number.

This program has been developed with children with special needs in Kindergarten through 8th grade in mind along with their siblings in Kindergarten through 5th grade. You'll be asked to provide more information about each child on the following pages. Child #1 should be one of your children with special needs.

ex. Autism, ADHD, ODD, sensory processing, etc.

Pizza (cheese or pepperoni)PopcornDonutsNone of these options - we will bring our own dinner.

e.g. feeding, toileting, playing, etc.

e.g. textures, loud sounds, intense smells, etc.

e.g. celebrations, inappropriate behavior, out-of-character behavior, etc.

Pizza (cheese or pepperoni)PopcornDonutsNone of these options - we will bring our own dinner

Yes, I would like to explain what my child needs to have the best time.No, this child doesn't need any specific support to have a good time!

ex. Autism, ADHD, ODD, sensory processing, etc.

e.g. feeding, toileting, playing, etc.

e.g. textures, loud sounds, intense smells, etc.

e.g. celebrations, inappropriate behavior, out-of-character behavior, etc.

Pizza (cheese or pepperoni)PopcornDonutsNone of these options - we will bring our own dinner

Yes, I would like to explain what my child needs to have the best time.No, this child doesn't need any specific support to have a good time!

ex. Autism, ADHD, ODD, sensory processing, etc.

e.g. feeding, toileting, playing, etc.

e.g. textures, loud sounds, intense smells, etc.

e.g. celebrations, inappropriate behavior, out-of-character behavior, etc.

Please CLICK HERE to sign up for Kids Night In.

Thank you for applying for Bridges!

Adult Contact Information

Emergency Contact #1 Information

Emergency Contact #2 Information

Child #1 Information

Child #1 Food & Drink Information

Child #1 Supports

Do you have a SECOND child to register?

Child #2 Information

Child #2 Food and Drink Information

Child #2 Supports

Do you have a THIRD child to register?

Child #3 Information

Child #3 Food and Drink Information

Child #3 Supports