MUHSEN is proud to provide Group Respite to families during conventions and events. We contribute happy and excited Certified Respite Volunteers to take care of your loved ones that have special needs.

Fill out a Respite Care Request Form

Caring for Caregivers

A young man with special needs sitting between two certified MUHSEN respite volunteers at Chicago Children's Museum.

We understand that taking care of a loved one for 24 hours a day, seven days a week, for years can be overwhelming and exhausting.

Oftentimes Caregivers do not take the breaks that they so preciously deserve. That is why MUHSEN has your back! We provide that break so that you can focus on other important things in your life. You can even take a nap!

Our Respite Care Volunteers

Our MUHSEN Certified Respite Care Volunteers undergo multiple steps in order to become certified. They are 18+ year old males and females that are dedicated to providing your family support and care.

Prospective Respite Care Volunteers go through an extensive online training as well as a training module created specifically for MUHSEN’s Respite Care Clients. Volunteers then undergo a Background Check and are finally verified as a Certified MUHSEN Respite Care Volunteer.

Certified Muhsen respite volunteer and a young boy with special needs are proudly showing their artwork.

Interested in requesting one of MUHSEN’s Respite Care Services?

Please use the forms below to provide us information on the Respite Care services you would like to request. Fill all applicable fields (*required) on these form:

Request a Respite Care Visit

Step 1 of 2

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Comments
This field is for validation purposes and should be left unchanged.
Caregiver's Name*
Caregiver's Phone Number*
Caregiver's Email Address*

Please check this email often as we will be contacting you through here.
When are these disability services needed?*
Provide dates and times. Be specific.
Where will these disability services be needed?
Provide full address
Where will these disability services be needed?*
Street Address Address Line 2 City Province Postal Code
Explain the nature of the Respite Request*
In home with caretaker present, At an event, etc
OPTIONAL: Enter payment amount*
One time payment or rate per hour
Please select the following*
- Male Volunteer
- Female Volunteer
- Does not matter
Consent*
I agree
in taking advantage of the service, to release and hold harmless MUHSEN, its officers, trustees, agents, and volunteers, from any and all claims, demands, suits, costs and charges, in connection with or arising out of the service, including, but not limited to, bodily harm or injury, except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by MUHSEN, its officers, trustees, agents and volunteers, and further authorize MUHSEN to administer, or cause to be administered, at my sole cost and expenses, medical treatment and/or medication to the above named child in the event of any emergency. In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the MUHSEN child care coordinator or person in charge to follow through with emergency treatment by a rescue squad, private physician, and/or hospital or emergency health care facility staff if needed. Any such action will be taken in the best interest of my child and will be reported to me as soon as possible
Print your Full Name below.*
This will count as your E Signature for the Liability Form above.

If you have already filled out this section from a previous request, you do not need to fill this out.

If you have NEVER filled out this section, every question must be answered for us to process the request.
Name of person using services?
Disability of person using services?
Age of person using services
Gender of person using services
- Female
- Male
What do they find challenging?
What do they find upsetting?
What is their best mode of communication?
Do they have some kind of supportive device? If they do, what is it?
How should one calm a negative behavior?
List any activities you would not like them to participate in / would like to limit:
Please be specific.
List any dietary restrictions for them
Include allergies and how life threatening they are
List any applicable information for toileting
This includes diapers, depends, assistance on the toilet, etc
Do they exhibit self injurious activities? Why? How can they be stopped?
This includes diapers, depends, assistance on the toilet, etc

Name
This field is for validation purposes and should be left unchanged.
Caregiver Full Name*
If you're filling this out for yourself, please write "peer"
Email*
Phone*
Peer's Name*
Peer's Disability*
Peer's Age*
Peer's Likes*
Peer's Dislikes*
Peer's Main Form of Communication*
i.e. verbal/nonverbal, communication board, ASL, etc
Would you prefer a male or female volunteer?*
- Female
- Male
- Does Not Matter

Email
This field is for validation purposes and should be left unchanged.
Caregiver Full Name*
If you're filling this out for yourself, please write "peer"
Email*
Phone*
Peer's Name*
Peer's Disability*
Peer's Age*
Peer's Likes*
Peer's Dislikes*
Peer's Main Form of Communication*
i.e. verbal/nonverbal, communication board, ASL, etc
Would you prefer a male or female volunteer?*
- Female
- Male
- Does Not Matter