Bridges Respite Sign Up

Bridges Respite Sign Up for November 22
Event Information

Special night designed for any kiddos with special needs grades kindergarten through 8th AND their typically developing sibling(s), kindergarten through 5th grade.

Kids will have the opportunity to engage in activities (e.g. sensory/quiet room with legos, books, building blocks, coloring, etc., craft room/game room, indoor play space), then have pizza, donuts, popcorn and a movie.

You do not need to be a member of the church. This is open to everyone.

Time: 6:00 pm - 8:30 pm

Address: Centenary Church 646 West Fifth Street Winston-Salem, NC 27101

Fall 2024 Respite Dates

November 22 - sign up closes November 18
Before you can sign your children up for any respite evenings, we must make sure we know you!
Have you completed the Bridges online application?*

YesNo
Thank you for letting us know!
How would you like to complete the application?

Please contact me by phonePlease contact me by emailI will complete application online
Please CLICK HERE to apply for Bridges Respite Program.
Phone Number
Please enter a valid phone number.
Email*
example@example.com
Best day(s) and time(s) to contact me is/are
What to bring?
Just yourselves! We will provide dinner (pizza, popcorn, donuts, and water) and themed activities. Kiddos who need a transitional security object could bring a stuffy/lovey/stuffed animal. Costumes without accessories or face coverings are permitted. We ask that you please leave the following at home: personal electronics, weapons (soft, foam, real, fake, any material), toys, art supplies/crafts, electronic stuffed animals. Thank you!

Please provide grown-ups name/emergency contact info and names of attendees.
Parent/Guardian Name*

PrefixFirst NameLast Name
Email at which you'd like to receive information about this event:*
example@example.com
Emergency Contact Number during this event*
Please enter a valid phone number.
How many children will attend respite?*
Child #1 Name*

First NameLast Name
Child #2 Name

First NameLast Name
Child #3 Name

First NameLast Name
Child #4 Name

First NameLast Name
This registration is for:*
I will pick up my child(ren) at or before 8:30 pm.*

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Bridges Respite Sign Up for November 22

Event Information

Fall 2024 Respite Dates

What to bring?

HIPAA