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Dementia Respite Care Advocates (DRCA) Grant Application

Please fill out the application information below.

If approved, a member of our team will be in contact with you for next steps.

Please note that these grants are reviewed quarterly and funds must be used in the quarter following approval.

Caregiver Information:

Birth Date
County of Residence
Gender
Relation to Care Receiver

Care Receiver Information:

Birth Date
County of Residence
Gender
Race
Marital Status
The care receiver: (check all that apply)

The Caregiver applicant recognizes and agrees that the Cody Owens Foundation, the Dementia Respite Care Advocates (DRCA), and all other agencies, entities and/or individuals participating in this respite  care program are not providing direct or indirect services of any kind to the Care Receiver identified above; and the Caregiver applicant agrees to and shall hold harmless and indemnify these participating agencies, entities and/or individuals for any and all damages, expenses or liabilities arising out of, or resulting from, the execution of this application. Completion of this application does not guarantee delivery of monies, anything of value, or services.

©2021 by Cody Owens Memorial Foundation.

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