Oklahoma Family Caregiver Respite Retreat Interest Form

1
Thank you for your interest in the respite retreat. Let's get started with a couple of questions. Ae you ther primary family caregiver of an individual (child or adult) with an intellectual or developmental disability?
YESNO
2
Thank you for your interest in attending a family caregiver respite retreat. The retreats are for family caregivers of individuals with developmental and/or intellectual disabilities.
3
Have you attended a caregiver retreat, such as a Sooner SUCCESS/DDCO or Wellspring Retreat, in the past?
YESNO
4
We plan to host multiple retreats across the state in 2025. We would love to connect with you to share more details about a retreat when one becomes available in your area of the state. At that time, we can share more details and collect the the required information to secure your registration. Note: There is no guarantee of retreat attendance as spots are limited. We will review interest forms in the order in which they are received. May we contact you by phone or email?
YESNO
5
Caregiver’s Name
First Name
Last Name
6
If approved to attend, will you be bringing a caregiver partner to the retreat?
YESNO
7
Name of Caregiving Partner
First Name
Last Name
8
Your Phone Number
Please enter a valid phone number.
9
Email Address
example@example.com
10
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Algeria
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Nauru
Nepal
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Nicaragua
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Nigeria
Niue
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Northern Mariana
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Palau
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Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
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Qatar
Republic of the Congo
Romania
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Rwanda
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Saint Helena
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Saint Lucia
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eSwatini
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Other
Country
11
Please let us know which COUNTY you live in.
12
If you are interested in locating a respite voucher program that will meet the needs of your family or are in need of any other resources, services, or information, please visit our website soonersuccess.ouhsc.edu or call us at 405-271-2710
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You must click "SUBMIT" below to complete your interest form. Thank you for your information. We will contact you to share more details on the retreat.
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