Innovative Services NW Teen Group Respite Need Survey
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Innovative Services NW, a local nonprofit organization, provides Group Respite care from 6:30 to 9:30 AM and from 2:30 to 7:00 PM Monday through Friday for special needs youth ages 13 through 17. Evergreen and Vancouver School Districts can bus from Innovative to school and from school to Innovative. The cost is $8.50 per hour and includes a light healthy after school snack. The ratio of workers to children is 3:1 and we can accommodate 18 children.

If you are interested in this type of care, we would like to know the following:

1. How many teenagers, who might require care, do you have?

2. Age of the teens listed above:

3. What school district does your teenager(s) attend?

4. How many hours of services a day would your teenager(s) require:

5. Which days of the week would your teenager(s) need our services? Please check all that apply.

 AMPM
Mon.
Tues.
Wed.
Thur.
Fri.

6. What are your teenagers' special needs?

7. If you would like us to contact you about our Group Respite Program for Teens, please provide information such as your name and phone number or email address.

Thank you for taking the time to complete the survey. Have a great day!

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