Social Nights Registration

New & Returning Participants
Participants that have not previously attended programming at AdaptAbilities must complete an intake prior to completing this registration form.
I have received services from AdaptAbilities before OR completed the intake process*
- Yes
- No

Registration will close 14 days before the start of each program or program session. While the registration form will remain open for those interested, we cannot guarantee program space or timely registration processing by the program start date. Our supervisors will work diligently to contact families who complete a program registration within the 14-day period.
Cost
- In-Person Social Nights is $150/session for funded participants
- $300/session for adults without funding directed towards staffing costs.
- Payment is due upon program confirmation.
I have a current funding agreement*
- PDD
- FSCD
- No Funding Agreement
Parent/Guardian Name*
First Last
Phone Number*
Email Address*
# of Participants
Participant Name*
First Last
Participant Date of Birth*
(dd/mm/yyyy)
DD slash MM slash YYYY
Age
(calculated automatically)
Participant Name 2*
First Last
Participant Date of Birth*
(dd/mm/yyyy)
DD slash MM slash YYYY
Age
(calculated automatically)
Participant Name 3*
First Last
Participant Date of Birth*
(dd/mm/yyyy)
DD slash MM slash YYYY
Age
(calculated automatically)
Select Social Night*
- Thursdays
- Fridays
Select Social Nights Group*
- Thursday: Teen Night - Ages 13 - 17 (McKernan Centre)
- Thursday: 18+ (Millbourne Market Mall)
- Thursday: 18+ (Orange Hub)
Select Social Nights Group*
- Friday: Pre-Teen Night (9-12) or Teen Night (13-17) (Millbourne Market Mall)
- Friday: Pre-Teen Night (9-12) or Teen Night (13-17) (McKernan Centre)
- Friday: Pre-Teen Night (9-12) or Teen Night (13-17) (Orange Hub)
Select Session(s)*
- Winter: Jan 9 - Mar 21, 2025
- Spring: Apr 3 - Jun 20, 2025
Additional Comments

AdaptAbilities Social Nights Form

Step 1 of 3

Cost

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