Weekend Respite Programs 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.
We are currently accepting registrations for 2024-2025

• Programs are all 11am - 4pm at minimum
• Program fees are non-refundable and are applied to all booked dates
• Cancellations must be received at minimum 14 days notice to avoid hourly billing
• Spots are first come/first served with all required documentation/fees paid
Cost
$5/day
$10/day - 13+
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 Location*
- Ages 3 – 12 - McKernan Centre
- Ages 3 – 12 - Millbourne Market Mall
- Ages 13 – 17 - Millbourne Market Mall
- Ages 3 – 12 - Orange Hub
- Ages 13 – 17 - Orange Hub
Select Session(s)*
- Select All
- Spring (Apr-Jun)
- Summer (Jul-Aug)
Select Day(s)
- Select All
- Apr 5
- Apr 12
- Apr 26
- May 3
- May 10
- May 24
- May 31
- June 7
- June 14
- June 21
Select Day(s)
- Select All
- Jul 5
- Jul 12
- Jul 19
- Jul 26
- Aug 9
- Aug 16
- Aug 23
- Aug 30
Additional Comments

AdaptAbilities Weekend Respite Programs Form

Step 1 of 3

Cost

Sorry! You cannot continue registration.