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Growing Futures for Children with Special Needs In the Madison Area

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Gio’s Garden Interest Form

Please fill out this form if you are interested in services at Gio's Garden. A staff will be in contact with you soon about the next steps to start receiving services. If you have any questions, you can call 608-833-4467 ext 4.

Initial Contact Form

Name*
Email*
Name of Child*
Child's Date of Birth*
Month
Day
Year

*Please note that Gio's Garden can provide services through the age of six.
How did you hear about Gio's Garden?*
Tell us about other services your child uses or qualifies for (e.g. Family Support and Resource Center, Respite Care, United Cerebral Palsy, IDS, WEAP, ACT)?*
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Does your child have access to Children's Long Term Support funding?*
- Yes
- No
- On Waitlist
Primary diagnosis and areas of challenge*
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Respite Services Interest:*
- Therapeutic Respite Care
- Inclusive Respite Care
*Please note that inclusive care is during evening respite hours and includes siblings up to age 10
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Therapy Services Interest:*
- Individual and/or Group Recreational Therapy
- Individual and/or Group Art Therapy
- Individual Skill Development
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Family Support Services Interest:*
- Caregiver/Parent Support Group
- Caregiver/Parent Art Therapy Group
- Family Art Therapy Group
- 1-1 Caregiver/Parent Coaching
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Virtual Services Interest:*
- Individual and/or Group Recreational Therapy
- Individual and/or Art Recreational Therapy
- Individual Skill Development
- Caregiver/Parent Support Group
- Parent Art Therapy Group
- Family Art Therapy Group
- 1-1 Caregiver/Parent Coaching
Days and hours you would be interested in using Gio's Garden*
Additional Comments

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Mailing Address:

2028 Parmenter St

Middleton, WI 53562

608-833-GIOS (4467)

[email protected]

Main Office Hours

Monday – Friday: 8:00am – 5:00pm

Middleton Center Hours

Monday – Friday: 8:00am – 8:00pm

Saturdays and Sundays: 9:00am - 4:00pm

Please call ahead to schedule a tour or an appointment.

GIO’S GARDEN IS A 501(C)(3) NON-PROFIT ORGANIZATION REGISTERED IN WISCONSIN
DONATIONS CAN ALSO BE MAILED TO: 2028 PARMENTER ST. MIDDLETON, WI 53562

Copyright � 2019 GIOS GARDEN.