Social Nights Registration

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Social Nights
I have a current funding agreement*
- PDD
- FSCD
- No Funding Agreement
I have received services from AdaptAbilities before*
- Yes
- No
Parent/Guardian Name*
First Last
Phone Number*
Email Address*
Participant Name*
First Last
Participant Date of Birth*
(dd/mm/yyyy)
DD slash MM slash YYYY
Age
(calculated automatically)
Cost
- In-Person Social Nights is $150/session
- Payment is due upon registration.
- We are currently accepting registrations for Fall (September- December).
In Person Social Nights
$150/Night - 6:00 - 8:00 pm (September 15 - December 15)
1 Night/Week – 5:30 – 9:30 pm September- December $150/Session
1 Night/Week – 5:30 – 9:30 pm September- December $150/Session
- Thursday: 18+ (McKernan House)
- Thursday: Teen Night - Ages 13 - 17(McKernan Centre)
Price: In-Person Social Nights
Price:
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Quantity: In-Person Social Nights
Please enter a number from 0 to 6.
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TOTAL COST: In-Person Social Nights
Payment Details
Mid-session Signup
I am registering in the middle of the session. AdaptAbilities will contact me to confirm my pro-rated registration fee.
Pre-Authorized Debit/Credit
I have pre-authorized debit/credit on file with AdaptAbilities.
Total Payment
$ 0.00 CAD
Credit Card*
Card Details
Cardholder Name

AdaptAbilities Social Nights Form