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Refer a Child

 

PLEASE BE ADVISED:

Rest Haven's offices will be closed November 21-24, 2023, and December 25-29, 2023.
Emergency Referral Grant applications will NOT be processed during that time. Thank you for your understanding.

 

To Refer a Child, fill out the online form below. Make sure to complete as much of the application as possible.
You will receive a copy of your submission via email.


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    Rest Haven Admin Use Only

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  • This form has been updated. Please fill in all required fields and be as specific as possible.

  • MM slash DD slash YYYY
  • Child's Information

    One child per referral form.
  • Rest Haven provides funding only to children ages 0-17 who permanently reside in San Diego County or Imperial County in the State of California. Please indicate in which county the child currently resides.
  • Parent(s) or Guardian(s) Information

  • All correspondence we send to the parent/guardian regarding donations for the child will be sent to this email address. Do not use social worker's or referring agency email. FAILURE TO PROVIDE AN EMAIL ADDRESS FOR PARENT/GUARDIAN WILL RESULT IN AUTOMATIC DENIAL.
  • Child's Health Information and Reason for Request

    Please be as specific as possible to avoid delays.
  • All requests must impact the child's health.
  • Describe the item, therapy, equipment, treatment, etc., and any other details needed for us to make a determination as to this request.
  • Provide details regarding the family's circumstances, including siblings/others living in home, family dynamics, employment and financial status, extenuating circumstances that lends support to request, other funding resources pursued, how request will impact child’s health and any other pertinent information to help in determination. If the child/family is NOT currently enrolled in Medi-Cal, please provide a gross estimate of 2023 income and expenses below.
  • Rest Haven’s mission is to provide funds for health related services for children in San Diego and Imperial counties when no other funds are available. You must describe other resources you have pursued in order to be considered.
  • (include tax & shipping, if applicable)
  • Upload any supporting documentation (if any), such as an invoice, medical documentation, etc. here.
    Max. file size: 50 MB.
  • Services Receiving

    Tell us what services the patient and/or their family is currently receiving.
  • (only check those that apply)
  • Vendor Information

  • Note where item/service can be purchased.
  • Information About Person Making the Referral

    Unfortunately we cannot accept self referrals. All Emergency Referral Grants must be made by a social worker, case worker, school administrator or counselor, or someone with similar professional credentials.

Rest Haven in the Community

Rest Haven Announces 2023 Special Grants Recipients

September 13, 2023

REST HAVEN AWARDS $207,872 TO 21 AREA NONPROFITS Rest Haven Children’s Health Fund (Rest.... Read More

Rest Haven Receives $2,100 in Donations

September 12, 2023

Rest Haven Children’s Health Fund raised $2,100 during the 2023 San Diego Gives campaign..... Read More

Contact Us

Cass Kaminetz, Executive Director executive@resthavenchf.org

10531 4S Commons Drive, Suite 166-806
San Diego, CA 92127
858.576.0590

© Copyright 2023 Rest Haven Children’s Fund

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