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Register Respite Provider

To publish your Respite Provider on the respite care resource database, please fill out the form below completely and accurately. Please allow 2-3 business days for us to review your submission and publish it.

Fields with * are required.

General Information

*Organization Name:
*Phone:
*Email:
*Website URL:
*Your Name:
*Your Title:

Location

*Address Line 1:
Address Line 2:
*City:
*State:
*ZIP:
*What Counties Do You Serve? (Select All That Apply)
Adams
Alamosa
Arapahoe
Archuleta
Baca
Bent
Boulder
Broomfield
Chaffee
Cheyenne
Clear Creek
Conejos
Costilla
Crowley
Custer
Delta
Denver
Dolores
Douglas
Eagle
ElPaso
Elbert
Fremont
Garfield
Gilpin
Grand
Gunnison
Hinsdale
Huerfano
Jackson
Jefferson
Kiowa
Kit Carson
La Plata
Lake
Larimer
Las Animas
Lincoln
Logan
Mesa
Mineral
Moffat
Montezuma
Montrose
Morgan
Otero
Ouray
Park
Phillips
Pitkin
Prowers
Pueblo
Rio Blanco
Rio Grande
Routt
Saguache
San Juan
San Miguel
Sedgwick
Summit
Teller
Washington
Weld
Yuma

Overview

*Program Description:
*Ages Served: (ie: All Ages, 55 and Over, etc)
*Disability/Needs Served: (ie: Elder Care, Autism, etc)
*Program(s) Available: (ie: Respite, Day Care, etc)
*Funding Accepted: (ie: Medicaid, Medicare, Private Pay)
*Language(s): (ie: English, Spanish, etc)
*Daily Living Activities: (ie: toileting, bathing, dressing, etc.)
*Availability: (ie: Weekdays, evenings, call for appt)
File Upload:

Resource Categories

Assigning categories to your resource is crucial in making it searchable in the database, and thus an accessible resource for the people who need it. Please take time to assign all categories that apply to your resource.

*Services Offered (Select All That Apply)

In-home
Center-Based
Day Program
Community Connections
Assisted Living/Skilled Nursing Facility
Overnight
Recreational/Camp
Transportation
Support Group

*Care Type (Select All That Apply)

Skilled (Medical)
Unskilled (Non-Medical)
Homemaker
Emergency/Crisis
Rehabilitation

*Ages Served (Select All That Apply)

Youth (Under 18)
Adults (18+)
Older Adults (55+)

*Disabilities/Needs Served (Select All That Apply)

Intellectual/Developmental Disability
Physical Disability
Memory Condition
Challenging Behaviors
Medical Support Needs
Activities of Daily Living Assistance (ADL's)
Mental Health Condition
Deaf/Hard of Hearing
Vision Impaired

*Funding Accepted (other than private pay) (Select All That Apply)

Medicaid/Waivers
Long Term Insurance
Scholarships/Financial Assistance Available
Free
Veteran Benefits

*Languages Spoken (if other than English) (Select All That Apply)

Arabic
Burmese
Chinese
Farsi
French
Hindi
Korean
Nepali
Russian
Spanish
Ukranian
Vietnamese
German
ASL
Italian
Czech

Other (Suggest New Categories)

If you think we should add new categories to our database, please include them below:

Finish & Submit


Must complete captcha before submitting

Contact Us:


Colorado Respite Coalition
393 S Harlan St, Ste 108
Lakewood, CO 80226

303-233-1666 Phone
303-233-1028 Fax

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