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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
Please enter first and last name.
Please enter first and last name.
Emergency Contact
Please enter first and last name.
Personal Information
Spring Adventure Trips 2021
(Socially distant party, music, recreation, social time, 50’s Memorabilia, walk into town, lunch and more)
(Workshops, nature trails, tour of the facility and grounds, learn about birds, lunch on the picnic grounds, volunteer work and more)
(Trails/hikes, hot lunch, mini golf, ice breakers, recreation, life skills, social time and more)
(Reserve trails and hiking, exploring with a tour guide, nature fun, lunch, workshop and more)
(Hikes and trails, recreation, social time, games, lunch, view of the water, dessert and more)
(Rain Date Sunday 5/23/21)
(Life Skills, learning to budget, walking, lunch, window shopping, social time, recreation, games and more)
(Recreation, fitness w/a professional trainer, gymnasium, workshops, lunch, social time and more)
(Outdoor fun, mall cardio, lunch, dessert, group selfies, scavenger hunt, recreation, social time and more)
(Live movie @ the City Center Theater, life skills, social time, recreation, lunch, window shopping and
(Exploring Ossining, waterfall trail, lunch at the beach, social and recreation time, dessert, games and 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.
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
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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.
