Authorized person(s) must be at least 18 years old.
Once this application is received the family coordinator will be calling to review more specific needs of your child/children.
Prescriber's Authorization
I authorize a trained volunteer of Under His Wings Respite to administer the medication.
I understand the person will be transported to the nearest hospital if an EpiPen is administered.

Download Forms

Please fill out the application forms and the consent form and please return them to:

Under His Wings Respite

4290 Hartland Center Road

Collins, Ohio  44726