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Request A Stay

Short Stays Respite Services

Submit a respite stay request for review. A stay is not confirmed until the Short Stays team reviews support needs, dates, availability, and the appropriate service level.

Before You Request a Stay

This page is for families who are ready to request weekend respite services. If you are unsure which level of support is needed, please complete a free consultation first.

1. Submit Your Request

Share your requested dates, caregiver information, and general support needs using the form below.

2. Team Review

Short Stays will review availability, walking accessibility, support needs, and the appropriate service level.

3. Confirmation & Next Steps

After review, Short Stays will contact you to confirm the details and provide next steps.

Important: This is a stay request form, not an automatic reservation. Payment should only be completed after Short Stays confirms the stay, service level, dates, and amount due.

Stay Request Form

Complete the form below to request a respite stay. The Short Stays team will contact you with next steps.

Requested Stay Details

Requested Check-In Date *

Requested Check-Out Date *

Preferred Drop-Off Time

Preferred Pick-Up Time

Requested Service Level

Parent/Caregiver Name *

Relationship *

Email Address *

Phone Number *

Individual's First Name *

Individual's Age *

Is the individual able to walk independently or with minimal assistance? *

Will DDS waiver services be used?

Support needs, routines, or questions

This is a request only. Short Stays will contact you before confirmation or payment. Please do not include emergency information or detailed private medical information in this form.

What Is Included

Weekend respite may include safe accommodations, meals, activities, personal care support, life skills support, and individualized planning based on the approved service level.

Overnight Respite Safe, supportive weekend accommodations.

Meals Included Nutritious meals during the respite stay.

Activities Community and recreational engagement.

Support Planning Person-centered care based on needs.

Accessibility Notice: Short Stays is not wheelchair accessible. Services are designed for individuals who are able to walk independently or with minimal assistance.

Need Help Requesting a Stay?

Phone: 203.787.8162
Email: [email protected]
Website: tpsshortstays.com