Hand in Hand - Quad City Special Needs Respite and Childcare Registration

For your convienence most of the forms can be filled out and submitted electronically or can be downloaded in either Word or PDF format to be filled out in advance. Along with the forms below, Hand-in-Hand will need a copy of your child’s current immunization record. This record must include the name and address of the clinic where the immunizations were received as well as the name of the medical professional who administered the immunization.

Physical .doc | .pdf
(to be filled out by physician)

Please contact the Hand-in-Hand office at (563) 332-8010 regarding the process of application for our programs for special needs and typical children.

Pre-registration is required for all Hand-in-Hand activities with at least two to four weeks notice needed for scheduling and funding. Personal assessment meetings and tours of our facility can happily be scheduled.

Payment for services comes from a variety of sources including state waiver fees, private pay, insurance, and donations from the community. Financial assistance is available. Please contact the Hand-in-Hand office at (563) 332-8010 for more information.