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

We are currently accepting registrations for Fall (September - December).

• 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 serve with all required documentation/fees paid
Cost
$5/day for McKernan Centre or Orange Hub
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 3 – 12 - McKernan Centre
- Ages 3 – 12 - Orange Hub
- Ages 13 – 17 - Head Office (Saturdays only) Please note: this program is not running - We are only collecting interest
Select Days*
- Saturdays
- Sundays
- Both
Saturdays
- Select All
- Sept 9
- Sept 16
- Sept 23
- Sept 30
- Oct 14
- Oct 21
- Oct 28
- Nov 4
- Nov 18
- Nov 25
- Dec 2
- Dec 9
- Dec 16
Hours
Before/After Care is only available Saturdays
Before & After Care
- Before Care (10:00 - 11:00 am)
- After Care (4:00 - 5:00 pm)
Drop Off Time

: Hours

Minutes

AM/PM
Pick Up Time

: Hours

Minutes

AM/PM
Sundays
- Select All
- Sept 10
- Sept 17
- Sept 24
- Oct 1
- Oct 15
- Oct 22
- Oct 29
- Nov 5
- Nov 12
- Nov 19
- Nov 26
- Dec 3
- Dec 10
- Dec 17

AdaptAbilities Weekend Respite Programs Form