Respite Catch Up Form

Parent Name *

First Name

Last Name

Child Name *

If you are sending two or more children to respite at King's Ranch Ministries, please fill out a separate form for each.

First Name

Last Name

What type of respite is your child coming for? *

Therapeutic

Motivational

Overall, how is it going at home? *

Things are going well!

We're doing ok.

We're struggling.

We're in crisis

How long have you been implementing Unplowed Ground in your home? *

6 months or less

1 year

2 years or more

What level of care are you currently in? *

Intensive Care Unit (Stations/No Roaming/High Nurture)

Hospital Room (Activity Box/No Roaming/High Nurture)

Out of the Hospital (Love and Logic Parenting)