Respite Application

If scheduling more than one child, please complete a separate application for each child.

Upon application and approval, a member of our team will be in touch to discuss scheduling and other details.

Our respite pricing is as follows:

Therapeutic Respite

  • Full Day – $165
  • Half Day – $82.50

Motivational Respite

  • Full Day – $240
  • Half Day – $120

**Please note this does NOT reflect holiday pay.**

Respite Application

Name of Primary Caregiver(Required)
Address(Required)
Are you an adoptive parent?(Required)
Are you a foster parent?(Required)
Have you completed Unplowed Ground Jumpstart or Pre-Adoptive?(Required)
Have you completed an Unplowed Ground Family Intensive?(Required)
Are you currently implementing Unplowed Ground parenting in your home?(Required)
Are you married or single?(Required)
If Married, Spouse's information
Address (if different that Primary Caregiver's)
Child's Name(Required)
MM slash DD slash YYYY
Does this child have a history of running away?(Required)
Does this child have a history of hurting animals?(Required)
Does this child have a history of making false allegations of abuse?(Required)
Is your child familiar with "stations"?(Required)
Is your child biological or adopted?(Required)
Emergency Contact(Required)
Type name below as your signature.