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David's Refuge Application

David’s Refuge is for parents or guardians who care full-time at home for children with special needs or life-threatening medical conditions.

This application is the first step in the reservation process. Current OPWDD eligibility (or equivalent documentation if you do not live in New York State) or medical documentation of a life-threatening disease is required and provides a baseline for determining your eligibility. We will also request a copy of your child’s current IEP (504 or IFSP if applicable.) If your child receives full time care at home but is not OPWDD eligible because their disability began after the age of 22 or if you have any other questions, feel free to contact us at 315-682-4204. If you have not visited our FAQ page, please do so by clicking here: FAQ’s

Please fill out the application below as thoroughly as possible to help us determine your eligibility. Once determined and space is available, we will be in touch to schedule your stay. If you are a single parent you are welcome to attend alone, bring a friend who has a child with special needs or a life threatening illness, or bring a significant other who assists in caring for your child.

 






















If applicable, please describe the level of care you provide for your child in each the following areas (the more detail you provide, the easier it will be to process your application)



















If you are not sent to the thank you page after submitting this form please check that all the required fields are filled in.

Do you have questions or need more information?
Call us at 315.682.4204 or email at : www.davidsrefuge.org/contact

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