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Cancellation fees may apply for program withdrawal. Please see our policies on the Registration Information page.
Participant Information
Please enter first and last name.
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Contact Information
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Please enter first and last name.
Emergency Contact
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Personal Information
Fall / Winter Fun Trips 2022
Join us for a nice dinner with friends at Lefteris in Mt. Kisco. Then take a short stroll to the Mt. Kisco Theater to enjoy a movie. Film title to be announced
Take a relaxing ride on the Metro North from Port Chester, NY train station to beautiful Norwalk, CT. Enjoy lunch, a stroll through the aquarium to learn and interact with aquatic life, both native and from far away places.
Take a ride to Campgaw in Mahwah, NJ for a fun day of snow tubing with friends. Lunch and van transportation to & from Tarrytown Train station included.
Join us at the SPARC Office in Yorktown Heights for a fun evening of games, snacks, silly commercials and of course the SuperBowl game.
Briarcliff Middle School Cafeteria 444 Pleasantville Rd Briarcliff Manor, NY 10510 - Music by: DJ Slinger
Meet us at The Westchester Mall in White Plains for lunch at the food court, check out the new indoor driving range and take a leisurely stroll through the mall. Do some window shopping or buy yourself a little something.
Meet us at SPINS in Mt. Kisco and get ready for some friendly competition. A few games of bowling, a meal, and test your gaming skills and enjoy the entertainment at the arcade.
Meet us at the White Plains Train Station and take a ride into NYC to enjoy lunch at the famous Katz's Deli and a quick stroll to fun at the nearby Museum of Ice Cream. Lunch and van transportation provided.
Meet us at Croton Corners in Croton-on-Hudson, NY. Place offers tea and traditional tea-party fare. Other food & beverages available for non-tea drinkers. Then, spend some time enjoying the retro arcade that includes NES, Super Nintendo, PACMAN, Wii & more!
Program Enrollment
If choosing Link Up, it must be chosen as Selection #1
Please check all that apply.
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 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 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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
If choosing Link Up, it must be chosen as Selection #1
Please select all that apply.
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.
Participation Consent
The participant has permission to participate in the activities registered for on this form.
I consent to receiving emails and/or text messages about the participant listed on this form.
I consent to allowing the participant to be transported and treated at the nearest medical facility.
I consent to photographs or videos of the participant being used for educational or SPARC promotion.
Billing Information
Price:
$0.00
$0.00
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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.
