Application for Children’s Family Relief Funding

Family Relief funding is allocated to provide respite to parents/guardians and create greater opportunities for those supported to live actively and participate in community activities. Family Relief funding can be used to pay for approved respite options such as; service fees of respite providers/direct support providers, residential respite, registered camps, community recreational programs, memberships and lessons.

Family Relief Funding only reimburses services for the person being supported and cannot reimburse services for the whole family. The funding is for activities outside of school and work hours, and cannot be used as daycare expenses while families are at work.

Criteria for Eligibility:
  • Children (under 18 years old) diagnosed with an Intellectual Disability and are living at home with their parent/guardian.
  • Geographic Area: The area bounded by Elmvale with Horseshoe Valley Road to the north, 9th line of Oro to the east, Simcoe County boundary to the south, Highway 27 up to Thornton and Base Borden from Highway 27 to 90 on the west.
Instructions to Complete:
  • Please complete all sections of the application form;
  • Please upload a copy of your child’s Psychological Assessment/Psycho-educational Assessment indicating a diagnosis of an Intellectual Disability;
  • The more complete your information is, the better we are able to assess your request for support;
  • The personal information that is collected is confidential and is used for the purpose of providing you with services and support under the Family Relief program.
  • If preferred, you may download, print and mail/drop off your application to:  Family Relief Program, 39 Fraser Court, Barrie, L4N 5J5.   For more information, please contact the Family Relief program at familyreliefadmin@empowersimcoe.ca or 705-726-9082 x 2261
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Child's Name
Child's Gender Identification
Choose as many as required.
Military Family?
Do you wish to identify this child as an Indigenous Person?

Diagnosis

Child has been diagnosed with:
Click or drag a file to this area to upload.

Section 2 of 3

Parent / Guardian Name
Address
Preferred Method of Contact
Preferred Language
Is this Parent / Guardian's address the same as above?
Child Lives at:

Section 3 of 3

Service Request

All Funding Being Received

ACSD (Assistance for Children with Severe Disabilities)
SSAH (Special Services at Home)
Ontario Autism Program
Recreational Funding (Health Star, Jump Start, etc.)
Other
Acknowledgement