Participant Information Participant Name* Please enter first and last name.
Has Your Address Changed?* Participant's Address
Participant's Residence Type Agency Name
Job / Program (Adults) OR School / Grade / Teacher (Youth)
Contact Information Has Parent / Guardian / House Manager Changed?* Parent/Guardian #1 / House Manager - Name Please enter first and last name.
Parent / Guardian #1 Home Phone
Parent / Guardian #1 Cell Phone
Parent / Guardian #1 - Email*
Would you like to add another parent/guardian? Parent / Guardian #2 Name Please enter first and last name.
Parent / Guardian #2 Home Phone
Parent / Guardian #2 Cell Phone
Parent / Guardian #2 - Email
Emergency Contact Has Your Emergency Contact Changed?* Emergency Contact Name Must be different than parent/guardian listed.
Emergency Contact Phone
Personal Information Has Your Personal Information Changed?* Self-Care Needs
Allergies
Adaptive Equipment
Seizures? Vision / Hearing Concerns:
More information you would like us to know about the participant:
Spring Adventure Trips 2022 Saturday 05/07/22 11:00am-3:30pm - Brunch and a Show: The Chris Perondi Dog Stunt Experience. Brunch included; transportation not provided. 11:00AM-3:30PM Respite $65 Non Respite $90
Please Choose One Saturday 05/07/22 11:00am-3:30pm - Brunch and a Show: The Chris Perondi Dog Stunt Experience. Respite: $65 Saturday 05/07/22 11:00am-3:30pm - Brunch and a Show: The Chris Perondi Dog Stunt Experience. Non Respite: $90
Sunday 05/15/22 12:00pm-6:00pm - Hudson Valley Renegades minor league baseball game. Round trip van transportation and dinner (ballpark concessions) included. 12:00PM-6:00PM Respite $80 Non Respite $135
Please Choose One Sunday 05/15/22 12:00pm-6:00pm - Hudson Valley Renegades minor league baseball game. Respite: $80 Sunday 05/15/22 12:00pm-6:00pm - Hudson Valley Renegades minor league baseball game. Non Respite: $135
Sunday 05/22/22 10:30am-5:00pm New York Botanical Garden in Springtime. Lunch, Metro North tickets and All-Garden pass included.10:30AM-5:00PM Respite $60 Non Respite $120
Please Choose One Sunday 05/22/22 10:30am-5:00pm New York Botanical Garden in Springtime. Respite: $60 Sunday 05/22/22 10:30am-5:00pm New York Botanical Garden in Springtime. Non Respite: $120
Friday 05/27/22 - Monday 05/30/22 - Overnight Adventure: Memorial Day Weekend at Camp Jewell All-inclusive family camp style weekend with water sports, arts and crafts, movies on the hill and more. Round trip van transportation provided. All inclusive (meals, activities,
accommodation in cabins for 3 nights). Before registering for this program, please email [email protected] for pre-approval.
Please Choose One Friday 05/27/22 - Monday 05/30/22 - Overnight Adventure: Memorial Day Weekend at Camp Jewell Respite $475 Friday 05/27/22 - Monday 05/30/22 - Overnight Adventure: Memorial Day Weekend at Camp Jewell Non-Respite $700
Summer Adventure Trips 2022 Saturday 06/11/22 10:00am-12:30pm - Community Gardening Day At the Garden of Hope in Yorktown Heights Learn how to grow your own food as you participate in planting, pruning, watering, weeding and digging at this community garden. Water, gloves and tools are provided. Participants should wear boots and bring along lunch.
Please Choose One Saturday 06/11/22 - Community Gardening Day Respite $25 Saturday 06/11/22 - Community Gardening Day Non-Respite $35
Sunday 06/12/22 12:00pm-05:00pm - Fitness & Italian Cuisine at the JCC, Tarrytown Create and sample Italian dishes and enjoy a day of active movement at the JCC Tarrytown. Please inquire about discount available for members of the JCC.
Please Choose One Sunday 06/12/22 - Fitness & Italian Cuisine at the JCC Respite $60 Sunday 06/12/22 - Fitness & Italian Cuisine at the JCC Non-Respite $120
Saturday 06/18/22 12:00pm-03:00pm - Saxon Woods Mini Golf White Plains Have lunch at Saxon Grill and play 19 - hole mini golf with friends at Saxon Woods Park in White Plains.
Please Choose One Saturday 06/18/22 - Saxon Woods Mini Golf White Plains Respite $60 Saturday 06/18/22 - Saxon Woods Mini Golf White Plains Non-Respite $120
Sunday 06/26/22 10:00am-04:00pm - Metropolitan Museum of Art, NYC Explore the exhibitions and have lunch at the MET ! Round trip van transportation and lunch provided. Drop off and pick up at 16 Ferris Avenue, White Plains.
Please Choose One Sunday 06/26/22 - Metropolitan Museum of Art Respite $140 Sunday 06/26/22 - Metropolitan Museum of Art Non-Respite $190
Saturday 07/02/22 10:30am-02:30pm - Hike & Lunch: Lyndhurst Mansion and the Old Meet at Lyndhurst Mansion and walk the beautiful grounds, then take a hike to Irvington on the OCA trail & have lunch at The River City Grille.
Please Choose One Saturday 07/02/22 - Hike & Lunch: Lyndhurst Mansion and the Old Respite $45 Saturday 07/02/22 - Hike & Lunch: Lyndhurst Mansion and the Old Non-Respite $100
Sunday 07/03/22 06:30pm-08:30pm - Independence Day Virtual Dance Party With guest DJ from magical memories entertainment
Please Choose One Sunday 07/03/22 - Independence Day Virtual Dance Party Respite $25 Sunday 07/03/22 - Independence Day Virtual Dance Party Non-Respite $35
Sunday 07/10/22 11:00am-03:00pm - Hammond Museum & Japanese Gardens, South Salem Enjoy the beauty of this 7 acre Japanese Stroll Garden , have lunch and view the special exhibits.
Please Choose One Sunday 07/10/22 - Hammond Museum & Japanese Gardens, South Salem Respite $60 Sunday 07/10/22 - Hammond Museum & Japanese Gardens, South Salem Non-Respite $120
Saturday 07/16/22 09:30am-05:30pm - Lake Compounce Amusement Park Bristol, CT Spend a day at New England's premier family theme and waterpark! Thrill rides, roller coasters, water rides and more! Includes park admission, lunch and round trip van transportation . Drop off and pickup will be at the SPARC office, 40 Triangle Center, Yorktown Heights.
Please Choose One Saturday 07/16/22 - Lake Compounce Amusement Park Respite $225 Saturday 07/16/22 - Lake Compounce Amusement Park Non-Respite $300
Sunday 07/24/22 06:00pm-09:00pm - A Midsummer Night's Queen - Rec Lawn, Chappaqua Lawnchair Theater Company presents a musical twist on this classic Shakespeare comedy, featuring live performances of Queen songs. Includes picnic dinner.
Please Choose One Sunday 07/24/22 - A Midsummer Night's Queen Respite $60 Sunday 07/24/22 - A Midsummer Night's Queen Non-Respite $120
Saturday 07/30/22 12:00pm-07:00pm - New York Yankees vs. Kansas City, Bronx, NY Take the Metro North down to Yankee Stadium to root, root, root for the home team at this day game! Drop off and pick up will be at the Dobbs Ferry Metro North station. Pricing includes concessions and train tickets.
Please Choose One Saturday 07/30/22 - New York Yankees vs. Kansas City Respite $200 Saturday 07/30/22 - New York Yankees vs. Kansas City Non-Respite $275
Sunday 08/07/22 05:30pm-08:30pm - A Tribute to Billy Joel, Jack Devito Field, Yorktown Heights Enjoy an outdoor concert featuring the music of Billy Joel. Includes picnic dinner.
Please Choose One Sunday 08/07/22 - A Tribute to Billy Joel Respite $40 Sunday 08/07/22 - A Tribute to Billy Joel Non-Respite $90
Saturday 08/13/22 12:30pm-03:30pm - Hudson River Cruise, Peekskill Take a cruise up the Hudson River on the Evening Star, a 36 - passenger tour boat. Bring lunch; snacks and drinks available onboard to purchase.
Please Choose One Saturday 08/13/22 - Hudson River Cruise Respite $45 Saturday 08/13/22 - Hudson River Cruise Non-Respite $100
Program Enrollment Selection #1 If choosing Link Up, it must be chosen as Selection #1
Please choose one Link Up VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC Live: SPIRIT LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens
Link Up: Number of Days Select 1 2 3 4 5
Link Up: Which Days? Season #1* Select Fall 2022 Spring 2022 Summer 2022
Location #1
Day(s) of the Week #1: Please check all that apply.
Program Fee #1 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:am - $500 (Non-Respite) LIVE: Horseback Riding 10:45:am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Link-up Program Fee* Please select number of days the participant will attend program each week. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One 5 Days Each Week - $700 4 Days Each Week - $600 3 Days Each Week - $400 2 Days Each Week - $325 1 Day Each Week - $250 Non-Medicaid Inquiry
Would you like to enroll for a 2nd activity?* Selection #2* If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC Live: SPIRIT LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #2 Select Fall 2022 Spring 2022 Summer 2022
Location #2
Day(s) of the Week #2 Please select all that apply.
Program Fee #2 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 3rd activity? Selection #3 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC Live: SPIRIT LIVE: Fall 2022 Miniature Golf LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #3 Select Fall 2022 Spring 2022 Summer 2022
Location #3
Day(s) of the Week #3 Please select all that apply.
Program Fee #3 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Social Club - $500 (Non-Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 4th activity? Selection #4 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC Live: SPIRIT LIVE: Fall 2021 Miniature Golf LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #4 Select Fall 2022 Spring 2022 Summer 2022
Location #4
Day(s) of the Week #4 Please select all that apply.
Program Fee #4 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 5th activity? Selection #5 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Horseback Riding LIVE: Club SPARC Live: SPIRIT LIVE: Fall 2022 Miniature Golf LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC LIVE: Social Club LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #5 Select Fall 2022 Spring 2022 Summer 2022
Location #5
Day(s) of the Week #5 Please select all that apply.
Program Fee #5 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Non-Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $425 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 6th activity? Selection #6 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC Live: SPIRIT LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #6 Select Fall 2022 Spring 2022 Summer 2022
Location #6
Day(s) of the Week #6 Please select all that apply.
Program Fee #6 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Fall 2021 Miniature Golf - $275 (Non-Respite) LIVE: Fall 2021 Miniature Golf - $175 (Respite) LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 7th activity? Selection #7 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC Live: SPIRIT LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #7 Select Fall 2022 Spring 2022 Summer 2022
Location #7
Day(s) of the Week #7 Please select all that apply.
Program Fee #7 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 8th activity? Selection #8 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC LIVE: Fall 2021 Miniature Golf LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC Live: SPIRIT LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #8 Select Fall 2022 Spring 2022 Summer 2022
Location #8
Day(s) of the Week #8 Please select all that apply.
Program Fee #8 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 9th activity? Selection #9 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC Live: SPIRIT LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #9 Select Fall 2022 Spring 2022 Summer 2022
Location #9
Day(s) of the Week #9 Please select all that apply.
Program Fee #9 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Would you like to enroll for a 10th activity? Selection #10 If choosing Link Up, it must be chosen as Selection #1
Please choose one VIRTUAL: Lifeskills VIRTUAL: Active and Fit VIRTUAL: Art VIRTUAL: Brunch Bunch VIRTUAL: Movie Night/Netflix & Friends VIRTUAL: Virtual Games Night LIVE: Horseback Riding LIVE: Club SPARC LIVE: Spring 2022 Miniature Golf LIVE: Club SPARC Live: SPIRIT LIVE: Social Club LIVE: 15 Week Film Production Workshop LIVE: 30 Week Film Production Workshop LIVE: Golf Clinic LIVE: Teen Time LIVE: Tennis Hotshots LIVE: 8 Week Bowling LIVE: Culinary Club LIVE: Dinner & a Movie LIVE: Morning Movement in the Park LIVE: Independence Day Virtual Dance Party LIVE: Winter Break Drumming Workshop for Teens Link Up
Season #10 Select Fall 2022 Spring 2022 Summer 2022
Location #10
Day(s) of the Week #10 Please select all that apply.
Program Fee #10 Please select the program you are registering for. The price will be displayed in the "total" field at the bottom of the page. Prices reflect Medicaid Respite eligibility. For non-medicaid prices please inquire.
Please Choose One VIRTUAL: Lifeskills - $450 nonrespite rate VIRTUAL: Lifeskills - $250 (Respite) VIRTUAL: Active and Fit - $425 nonrespite rate VIRTUAL: Active and Fit - $240 (Respite) VIRTUAL: Art - $485 nonrespite rate VIRTUAL: Art - $275 (Respite) VIRTUAL: Brunch Bunch - $400 nonrespite rate VIRTUAL: Brunch Bunch - $220 (respite) VIRTUAL: Movie Night/Netflix & Friends - $400 nonrespite rate VIRTUAL: Movie Night/Netflix & Friends - $220 (Respite) VIRTUAL: Virtual Games Night - $250 (Respite) VIRTUAL: Virtual Games Night - $450 (Non-Respite) LIVE: Horseback Riding 10:00am - $285 (Respite) LIVE: Horseback Riding 10:45am - $285 (Respite) LIVE: Horseback Riding 10:00am - $500 (Non-Respite) LIVE: Horseback Riding 10:45am - $500 (Non-Respite) LIVE: Club SPARC $550 Live: SPIRIT - FREE LIVE: Spring 2022 Miniature Golf - $275 (Respite) LIVE: Spring 2022 Miniature Golf - $325 (Non-Respite) LIVE: Club SPARC - $485 nonrespite rate LIVE: Club SPARC - $275 (Respite) LIVE: Social Club - $275 (Non-Respite) LIVE: Social Club - $200 (Respite) LIVE: 15 Week Film Production Workshop - $625 (Non-Respite) LIVE: 15 Week Film Production Workshop - $385 (Respite) LIVE: 30 Week Film Production Workshop - $750 (Respite) LIVE: Golf Clinic - $250 (Non-Respite) LIVE: Golf Clinic - $150 (Respite) LIVE: Teen Time - $275 (Non-Respite) LIVE: Teen Time - $200 (Respite) LIVE: Tennis Hotshots - $450 (Non-Respite) LIVE: Tennis Hotshots - $375 (Respite) LIVE: 8 Week Bowling - $325 (Non-Respite) LIVE: 8 Week Bowling - $250 (Respite) LIVE: Culinary Club - $285 (Respite) LIVE: Culinary Club - $375 (Non-Respite) LIVE: Dinnner & a Movie - $375 (Respite) LIVE: Dinnner & a Movie - $500 (Non-Respite) LIVE: Morning Movement in the Park - $125 (Respite) LIVE: Morning Movement in the Park - $175 (Non-Respite) LIVE: Independence Day Virtual Dance Party - $25 (Respite) LIVE: Independence Day Virtual Dance Party - $35 (Non-Respite) LIVE: Winter Break Drumming Workshop for Teens - Free
Participation Consent Participation Consent:* The participant has permission to participate in the activities registered for on this form.
Communication Consent:* I consent to receiving emails and/or text messages about the participant listed on this form.
In the event of an emergency:* I consent to allowing the participant to be transported and treated at the nearest medical facility.
Photography Consent* I consent to photographs or videos of the participant being used for educational or SPARC promotion.
Billing Information Credit Card Transaction Fee Acknowledgement* Transaction Fee*
Price:
$0.00
Total
$0.00
Billing Name*
First
Last
Billing Address*
Billing Phone*
Billing Email*
Credit Card Parent / Guardian / Agency Signature* My signature is valid for ongoing enrollment in SPARC unless otherwise indicated.
By participating in SPARC programs, the parent/guardian of each participant and the participant agree to indemnify, release and hold harmless SPARC, its officers, directors, employees, consultants, agents (including independent contractors, if applicable), and volunteers from any and all liability or causes of action whatsoever arising out of, or which may result from such participation.
CAPTCHA