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A Family For Every Child
Heart Gallery

541-343-2856
877-343-2856 christy@afamilyforeverychild.org

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Tax I.D. 20-4151057
Christy Obie~Barrett
Executive Director
880 Beltline Road
Springfield, OR 97477
fax 541-343-2866

OUR MISSION:
To find loving, permanent families for every waiting foster child.


 
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Heart Gallery Breathing Space Volunteer Program

Respite/Support care


Date:

First Name:
 
Last Name:
 
Date of birth:
 
Social Security #
 
Male: Female:  
     
First Name:
 
Last Name:
 
Date of birth:
 
Social Security #
 
Male: Female:  
     
Street address:
 
City:
 
State:
 
Zip:
 
   
Emergency Contact (1):
   
Emergency Contact (2):
E-mail Address (REQUIRED)
   
What are your interests and hobbies:


Arts/crafts
Office Work
Computer
Work
Reading
     
 
Writing
Home Skills
Sports or Games
 
 
Education
Other

Bi-lingual / language(s) spoken :

In what way would you like to be involved in the breathing space program?

Life Skills Partner: 1 yr. commitment, one on one instruction such as cooking, cleaning, automotive, self-care, volunteering in the community, gardening, animal care, painting, art projects, all volunteered based, any age child participate, etc.  Orientation available held once a month for new individuals joining the program.

Volunteer Drivers: Used to help foster families, available to drive children to Dr. appointments (with case worker permission), after school activities, games, other appointments that foster parents aren’t needed, can be included in activities that they are driving children to, volunteer run, etc.

Drop-In Center: Volunteering at a once a week activity that is for older children to come in and have a place of respite, Run by Heart Gallery volunteers (all volunteers cleared by AFFEC), and can be held at local community centers, Willamalane, NAAG.

Fun-Time Coordinator: Self-sustaining program centered on developed activities that meet either weekly or monthly for the children, can be crafts, movies, game nights, sport nights, etc.  This group will meet with the Life Skills Partner group and the Volunteers for driving every three months to plan for the activities that each group will provide and to help get individuals involved in the appropriate group.

Respite Care: More skilled individuals, training provided for families in areas of weakness/lack of experience, General Orientation, mandatory meeting every 6 months to check-in, etc.

Weekend Warriors: If you’re not able to take on Monday-Friday care but are able to take on planned care for the weekend to allow relief for families.

Time-Out Parents: Respite Parents who are available for a longer timeframe. These parents are open to taking children for one to two weeks at a time in order to provide a break for care givers.

Emergency Parents: Individuals who can be short notice care givers. This can be for a weekend to weeks, extending into months.

What are your expectations out of the breathing space program?

Have you had any training for this type of volunteering? If no, what type of training would you like more information on?

What days and times are you available?

Monday
Morning
Tuesday
All day Morning Afternoon Evenings
Wednesday
All day Morning Afternoon Evenings
Thursday
All day Morning Afternoon Evenings
Friday
All day Morning Afternoon Evenings
Saturday
All day Morning Afternoon Evenings
Sunday
All day Morning Afternoon Evenings