Respite and routines

Continuity of care and respite sheet

A one-page handoff for a respite caregiver: routines, comfort, medical needs, and who to call.

Fill this out before a respite stay, a visit, or any time another adult is caring for the child. It is a worksheet, not an agency form. Update it when routines change.

Child

Name ____________________________________   Preferred name ________________

Date of birth ______________   Pronouns ______________

Today’s caregiver

Name ____________________________________   Phone ________________

Backup adult ____________________________________   Phone ________________

Daily rhythm

Wake ______________   School or daycare ______________   Home ______________

Meals and snacks the child counts on:

________________________________________________________________

Bedtime routine, including what helps them settle:

________________________________________________________________

Comfort and stress

Comfort items: __________________________________________________

What helps after a hard moment: ____________________________________

What to avoid: __________________________________________________

Words or topics that are private: ____________________________________

Health

Allergies ________________________________________________________

Medications, dose, and time ________________________________________

Doctor ________________________________   Phone ________________

How the child takes medicine: _______________________________________

If something is wrong

Call the caregiver first. If it is an emergency, call 911, then the caregiver.

Caseworker, if any __________________________   Phone ____________

Notes for this stay: ________________________________________________

Updated 2026-10-10.