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Annual Reports
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Get Involved
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AdaptAbilities Weekend Respite Programs Form
Home
Weekend Respite Programs Registration
Step
1
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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
Summer (July- August).
NEW!
Dates for May - August available to choose from at Millbourne
• 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
*
Participant Name
*
First
Last
Participant Date of Birth
*
(dd/mm/yyyy)
DD slash MM slash YYYY
Age
(calculated automatically)
Select Location
*
Ages 13 – 17 - Millbourne Market Mall
Ages 3 – 12 - Orange Hub
Ages 13 – 17 - Orange Hub
Days
Select All
May 4
May 11
May 25
Jun 1
Jun 8
Jun 15
Jun 22
July 6
July 13
July 20
July 27
Aug 10
Aug 17
Aug 24
Saturdays
Select All
July 6
July 13
July 20
July 27
Aug 10
Aug 17
Aug 24
Hours
I require standard hours - 11:00 AM to 4:00 PM
I require before/after care (*hourly rates apply)
Before & After Care
Before Care (10:00 - 11:00 am)
After Care (4:00 - 5:00 pm)
Drop Off Time
:
Hours
Minutes
AM
PM
AM/PM
Pick Up Time
:
Hours
Minutes
AM
PM
AM/PM
Sorry! You cannot continue registration.
Hi there! If you are new to AdaptAbilities, you must complete an intake prior to registering for programming.
To book an intake, please call our office at 780-431-8446 or submit a service request
here.
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