Respite Intake Form

ICNA Respite Registration 2026
May 23rd, 2026: 12pm - 8PM (break 4pm - 6pm) May 24th, 2026: 12pm - 8pm (break 4pm - 6pm). By completing this form, you have registered for disability accommodations at ICNA. Location: Baltimore Convention Center 1 W Pratt St, Baltimore, MD 21201 Contact: maryland@muhsen.org or volunteer@muhsen.org with any questions. This is for individuals with special needs only. All participants are still required to purchase tickets through the ICNA website.
Respite Dates: May 23rd - 24th, 2026. The respite Care program will be in partnership with The Malaikah Foundation for children & adults with disabilities.
Caregiver Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender of participant
Name of Participant

First NameLast Name
Disability of Participant:
Age of Participant
Do they have some kind of supportive device? If so, what is it?
What is their best mode of communication?
What do they find challenging?
What are the challenging behaviors we are likely to see when they are upset?
How should one calm a negative behavior?
List any dietary restrictions for them? Do they have any allergies? Any food sensitivities/texture sensitivities
List any applicable information for toileting
What are their preferred activities?
What are some strengths of theirs that we can build on?
Is there any additional information you would like to share?
I give permission to MUHSEN to photograph, film, or videotape your participant. All pictures/recordings can be legitimately used without any limitation or reservation for reasons of safe and appropriate purposes such as publicity, illustration, advertising, and web content. Choose an option:
Please provide the necessary information to properly take care of your participant. I understand that bringing my family to partake in MUHSEN's event is my decision. I hereby assume all responsibility for any and all risk of property damage or bodily injury that I may sustain while participating in any activity of any nature. Further, I, for myself and my heir, executors, administrators and assigns, hereby release, waive and discharge MUHSEN and its officers, directors, employees, agents and volunteers of responsibility. I give permission to MUHSEN to photograph, film, or videotape your child. All pictures/recordings can be legitimately used without any limitation or reservation for reasons of safe and appropriate purposes such as publicity, illustration, advertising, and Web content.
Should be Empty:

ICNA Respite Registration 2026

Respite Dates: May 23rd - 24th, 2026. The respite Care program will be in partnership with The Malaikah Foundation for children & adults with disabilities.