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TherapeuticRecreationProgram FALL 2018 /
WINTER 2019
eastersealswcpenna.orgEasterSeals Western and Central Pennsylvania
Presented in Part by
Mack Madness Inc.
York Community Foundation
Ambassador Foundation
Thank You to our recreation program donors:
Utz Quality Foods
Baltimore Life
Wells Fargo
The Stabler Foundation
Donna Deerin Ward
Damian Salvi
Glatfelter Insurance Group
DOCEO Office Solutions
Sponsors
Gamler’s Boatyard and Campground
Pequea Water Ski Club
The McAllister Foundation
United Concordia
Jan Kevern MemorialGolf Tournament
Sageworth Trust Company(Arlene Utz Hollinger Foundation)
Chris and Angela Ferro
383 Rolling Ridge Dr. State College, PA 16801 888-372-7280 (toll-free)
Corporate OfficeSix Parkway Center, Suite 150, 875 Greentree Road, Pittsburgh, PA 15220Phone: 412-281-7244
2550 Kingston Rd. Suite 219, York, PA 17402Phone: 717-741-3891 / Fax: 717-741-5359
EASTERSEALS WESTERN AND CENTRAL PENNSYLVANIA
EasterSeals Locations
Matthew B. Ernst; CTRSVice President, Programs & Business Development, Central [email protected]
James G. BennettPresident and [email protected]
Allison ScottTherapeutic Recreation Program Specialist – Camping and Respite [email protected]
Virginia Anderson; CTRSDirector of Therapeutic [email protected]
Elizabeth Bunting; CTRSTherapeutic Recreation Program Coordinator – Camping and Respite [email protected]
CHECK US OUT ON FACEBOOK AT www.facebook.com/eastersealswcpa
We would Love FOR YOU TO JOIN US!
TABLE OF CONTENTSWelcome & Mission Statement 4
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7
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5
10
11
13-14
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Waivers 15-16
ACES - Achieving Community Experiences & Skills
Recreational Horseback Riding
Bowling
“Splash It Up” Aquatics
SaturDay Camp
Adapted Snow Sports
Club Lily Adult Respite Weekend
Project Beacon Military Respite Weekend
Registration Form
WELCOME
OUR PURPOSE
Many adventures and new leisure experiences await you during the fall and winter of 2018/2019! We are excited to continue offering a wide variety of community-based programs throughout the region including aquatics, horseback riding, bowling and a variety of social groups. Adventure programs such as snow skiing will also be offered while preparing for our spring and summer programs and camps.
We continue to offer camp experiences like no other. Whether it is our Club Lily Weekend Retreat or Project Beacon, we are expecting to see many of you again this fall and winter!
We look forward to having you join us in activities where you can learn, have fun and make new friends.
Matt Ernst; CTRSVice President, Programs &
Business Development, Central [email protected]
Easterseals is changing the way
the world defines and views
disability by making profound,
positive differences in people's
lives every day.
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RECREATIONAl horseback ridingEasterseals Recreational Horseback Riding is a six-week program providingchildren and adults with special needs the opportunity to enjoy horses whileriding and learning new skills. As the weeks progress, riders will become morecomfortable, sit higher in their saddle, participate in activities, and learn to controltheir horses through reins work and other activities. Volunteers and staff workwith riders to make recreational riding both fun and therapeutic. Benefits includeimproved self esteem, enhanced balance, improvement in both fine and gross motorskills and increased strength.
A doctor’s note is required for participation in this program.
Star Stables Sessions:(York County - Red Lion)
Tuesday EveningsOct. 30 - Dec. 4, 2018 5:00 PM – 5:35 PM
5:40 PM – 6:15 PMCost: $240.00 per 6:20 PM – 6:55 PMsix weeks 7:00 PM – 7:35 PM
7:40 PM – 8:15 PM
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BOWLING
ABC West Friday EveningsOct. 5 - Dec. 14, 2018
(OFF Nov. 23rd)Jan. 11 - March 15, 2019
Oct. 4 - Dec. 13, 2018(OFF Nov. 22nd)
(Location TBD)Jan. 10 - March 14, 2019
Sessions:
Strike up new friendships while having fun! Proper bowling techniques will be taught along with an explanation of rules and scoring. Participants will improve hand-eye coordination, socialization, and range of motion. Adaptive ramps and other modifications are available for those with special needs.
(Mechanicsburg) 5:30 PM – 7:00 PM(Cumberland County)
Includes 2 games,
shoes, pizza or
Includes 2 gamesand shoes.
Cost: $125.00 per hot dog, chips andten weeks
Cost: $125.00 perten weeks
Cost: $125.00 perten weeks
a drink.
ABC East Thursday Evenings
Oct. 4, 2018 - Jan. 3, 2019
Nov. 22 and Dec. 27)(OFF Oct. 25, Nov. 15,
(OFF Jan. 31)Jan. 10 - March 21, 2019
Thursday Evenings
Sessions:(Dauphin County) 5:00 PM – 6:30 PM
Includes 2 games,
shoes, pizza or
hot dog, chips and
a drink.
Laser Alleys(York County)
Sessions: 6:00 PM – 7:30 PM
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"SPLASh it up” Aquatics - New Night in York!Nothing says fun and excitement like swimming! Our “SPLASH IT UP” AQUATICS program has been designed to accommodate the needs and abilities of each individual participant with a disability or special needs. Lessons will be conducted with a 1:1 or 1:2 instructor to participant ratio. In addition to teaching water safety skills and swimming techniques, this program seeks to enhance the development of physical fitness and appropriate social interaction skills. Please Note: Participants will be placed into time slots and notified of the schedule after the registration deadline.
York YMCA (
Thursday Evenings (NEW NIGHT) Sessions:(York County) Nov. 8, 2018 - Jan. 10, 2019
(OFF Nov. 22 and Dec. 27)Jan. 24 - March 14, 2019March 28 - May 16, 2019
Friday EveningsOct. 26 - Dec. 21, 2018
(OFF Nov. 23)
(OFF April 19)
Jan. 11 - March 1, 2019March 22 - May 17, 2019
5:45 PM – 6:15 PM
Cost: $120.00 pereight weeks
Cost: $120.00 pereight weeks
Cost: $120.00 pereight weeks
6:15 PM – 6:45 PM
6:45 PM – 7:15 PM
East Shore YMCA Sessions:(Dauphin County)
(OFF Nov. 22 & Dec. 27)Jan. 31 - March 21, 2019April 4 - May 23, 2019
5:30 PM – 6:00 PM
6:00 PM – 6:30 PM
6:30 PM – 7:00 PM
The Carlisle Family YMCA Thursday Evenings Sessions:(Cumberland County) Nov. 15, 2018 - Jan. 17, 2019 5:00 PM – 5:30 PM 5:30 PM – 6:00 PM
6:00 PM – 6:30 PM
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SaturDAY CAMP - NEW!
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SaturDay Camp
Locations: Varied
Dates:
November 10, 2018 - Church of the Open Door (York County)
December 15, 2018 - Under the Horizon Pottery Studio (Adams County)
January 26, 2019 - Church of the Open Door (York County)
February 2019 (Date TBD) - Baughman Memorial United Methodist Church (Cumberland County)
Ages: 5-22
Cost: $75.00 per day
Our SaturDay Camp is an extension of our summer day camp program. It is specifi-cally designed for individuals with disabilities. There will be four, one-day camps throughout the fall and winter. Each day of camp will operate from 9-5. It is intended to be both fun and educational for all who participate. It is also intended to provide caregivers an extended period of time on a weekend once a month to freely engage in activities of their choosing. The SaturDay camps will be held at various locations and will have themes for each session that will engage campers of all levels in activities such as arts and crafts, group games, sensory activities, snack time, STEM activities, and there will be special guests.
20 registrations will be accepted for each session. Please be sure to register early to guarantee your spot. Please note that campers are expected to be able to follow verbal cues and directions. Campers needing 1:1 behavioral support as well as those that may have a fragile medical condition will be required to have a non-parental support person, over the age of 18, at each day of camp. Easterseals provides an overall staff to camper ratio of 1:3/1:4.
ACES - Achieving communityexperiences & Skills
ACES - Social Group Monday Evenings
Ages 14+Fall Session: Oct. 1 - Dec. 17, 2018 (OFF Oct. 8th and Nov. 26th)
Winter Session: Jan. 7 - March 18, 2019 (OFF Feb. 18th)
Time and locations will vary.A schedule of locations and activities will be sentcloser to the start.
(York County)
Cost: $150.00 per 10-weeks
Our ACES (Achieving Community Experiences and Skills) program has been created for individuals with high-functioning autism. Get in on the fun and adventure of these social groups where interactive experiences will be positive and memorable! Social interaction and participation is encouraged in a relaxed and comfortable environment. Become part of the ACES group today.
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CLUB LILY ADULT RESPITE WEEKEND
Location:
Ages:
Dates:
Cost:
Camp Victory (Millville, PA) and Camp Joy El (Greencastle, PA - Franklin County)
18–101 years old
Friday, Oct. 12 (6pm) - Sunday, Oct. 14, 2018 (1pm) Camp VictoryFriday, Nov. 16 (6pm) - Sunday, Nov. 18, 2018 (1pm) Camp VictoryFriday, April 12 (6pm) - Sunday, April 14, 2019 (1pm) Camp Victory
$375.00
(Includes snack on Friday, 3 meals on Saturday, andbreakfast and lunch onSunday)
Our Club Lily Weekend Retreat is a great way to take a break from your everyday activities and enjoy nature, games, friends, and fun! Activities will include arts and crafts, group games, a climbing wall, bonfires and more! You don’t want to miss out on this great weekend!
Our fall weekends will be held at Camp Victory. It is a fully accessible camp that offers us the opportunity to enjoy nature and exciting program that can accommodate everyone.
Our weekend retreats are for adults of all functioning levels. We staff the weekend at a 1:3 counselor-to-camper ratio. There will be certified/licensed Health Staff at camp to assist with medication administration and basic health concerns. Our exceptional staff goes through training and is dedicated to providing the best care possible for all of our campers. In order to maintain the highest quality of care with our ratio we ask that campers needing one-on-one behavioral support as well as those with fragile medical conditions bring a non-parent support person, over the age of 18, to camp with them (we handle these circumstances on a case-by-case basis and ask that you contact us if you feel that your camper may fall into this category).
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PROJECT BEACON MILITARY RESPITE WEEKEND
Location: East - Camp Victory (Millville, PA – Columbia County)
Dates: Friday, Oct. 19 (6pm) - Sunday, Oct. 21, 2018 (1pm) Friday, April 5 (6pm) - Sunday, April 7, 2019 (1pm)
Ages: 5–17 years old
Cost: FREE (Includes snack on Friday, 3 meals on Saturday, andbreakfast and lunch on Sunday)
This weekend, subsidized by in part by Highmark, United Concordia and the PA National Guard is specifically for the children (with and without special needs) of active military members and veterans. The camp is an opportunity for Easterseals to serve our military families and it’s a great chance for the kids to get away and enjoy some time at camp. We will be playing games, doing arts and crafts, trying out the climbing wall and zip line, eating s’mores and so much more! Join us for one of these fun weekends!
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Ski Liberty (Adams County)
Ages: 6+
Dates: 2 Weekends in January/February 2019 Morning and afternoon lessons are available each day
Cost: $100.00 per lesson (Includes equipment and lift tickets)
ADAPTED SNOW SPORTS
This is an exceptional program for children and adults of all abilities. Adaptive equipment is available for individuals who are non-ambulatory. Each individual will have a minimum of 1:1 instruction. The basics of snowskiing or snowboarding will be covered while having a great time on the slopes. Be sure to register immediately if interested!
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REGISTRATIOn form
PLEASE PRINT:
____________________________________ Sex: M F _____
______
First and Last Name
Height
Weight
____________________________________________________________Address
_____________________________
______________
_____________
City
State
Zip
_________ _________________________
________________________
Age
Disability
Phone (with area code)
____________________________________________________________Email Address
______________________________ _____________________________
Work Phone
Cell Phone
____________________________________________________________Emergency Contact (other than parent or guardian)
______________________________ _____________________________
Relationship to Participant Phone Number(s)
Please return the registration form with payment to:Easterseals Therapeutic Recreation, 2550 Kingston Rd. Suite 219,York, PA 17402. It is the participants (parents and guardians) responsibility to provide Easterseals with the most up-to-date information on allergies, medications, behaviors, etc.
Please check here if the parent/guardian is an active member of the military or a veteran.
PLEASE NOTE: Annual Registration Fee (payable once per calendar year)
$20.00 - one participant $35.00 - two participants $45.00 - family
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Bowling:
ABC West – Jan. 11 - March 15, 2019 ($125.00)
ABC East – Oct. 4 - Dec. 13, 2018 (OFF Nov. 22nd) ($125.00)
ABC West – Oct. 5 - Dec. 14, 2018 (OFF Nov. 23rd) ($125.00)
PROGRAM PAID BILL
Recreational Horseback Riding:Star Stables – Oct. 30 - Dec. 4, 2018 ($240.00)
Fall Session – Oct. 1 - Dec. 17, 2018 (OFF Oct. 8th & Nov. 26th) ($150.00)
“Splash it Up” Aquatics:York YMCA – Nov. 8, 2018 - Jan. 10, 2019 (OFF Nov. 22nd & Dec. 27th) ($120.00)
York YMCA – Jan. 24 - March 14, 2019 ($120.00)
York YMCA – March 28 - May 16, 2019 ($120.00)
East Shore YMCA – Oct. 26 - Dec. 21, 2018 (OFF Nov. 23rd) ($120.00)
East Shore YMCA – Jan. 11 - March 1, 2019 ($120.00)
East Shore YMCA – March 22 - May 17, 2019 (OFF April 19th) ($120.00)
Carlisle YMCA – Nov. 15, 2018 - Jan. 17, 2019 (OFF Nov. 22nd & Dec. 27th) ($120.00)
Carlisle YMCA – Jan. 31 - March 21, 2019 ($120.00)
Carlisle YMCA – April 4 - May 23, 2019 ($120.00)
SaturDay CampChurch of the Open Door (York Co.) – Nov. 10, 2018 ($75.00)
Under the Horizon Pottery Studio (Adams Co.) – Dec. 15, 2018 ($75.00)
Church of the Open Door (York Co.) – Jan. 26, 2019 ($75.00)
ACES Achieving Community Experiences & Skills:
ABC East – Jan. 10 - March 14, 2019 (Location TBD) ($125.00)
Laser Alleys – Oct. 4, 2018 - Jan. 3, 2019 (OFF Oct. 25, Nov. 15 & 22, Dec. 27) ($125.00)
Laser Alleys – Jan. 10 - March 21, 2019 (OFF Jan. 31st) ($125.00)
Baughman Memorial United Methodist Church (Cumberland Co.) – Feb. 2019 (TBD) ($75.00)
Club Lily Respite – Oct. 12 - Oct. 14, 2018 (Camp Victory) ($375.00)
Club Lily Respite – Nov. 16 - Nov. 18, 2018 (Camp Victory) ($375.00)
Club Lily Respite – April 12 - April 14, 2019 (Camp Victory) ($375.00)
PB Military Respite – Oct. 19 - Oct. 21, 2018 (Camp Victory) (FREE)
PB Military Respite – April 5 - April 7, 2019 (Camp Victory) (FREE)
Ski Liberty – January/February 2019 - TBD (Weekend 1 - AM) ($100.00)
Ski Liberty – January/February 2019 - TBD (Weekend 1 - PM) ($100.00)
Ski Liberty – January/February 2019 - TBD (Weekend 2 - AM) ($100.00)
Ski Liberty – January/February 2019 - TBD (Weekend 2 - PM) ($100.00)
Respite Programs:
Winter Session – Jan. 7 - March 18, 2019 (OFF Feb. 18th) ($150.00)
Adapted Snow Sports
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PARTICIPANt information form
Name ___________________________________________________________________________
Address _________________________________________________________________________
City __________________________State ____________________ Zip ______________________
Male ___________ Female ____________ Birth date ___________________________________
Race ________________________________________
Home Phone or TTY (717) __________________________________________________________
E-mail __________________________________________________________________________
Parent or Guardian Name __________________________________________________________
______________________________________________
Relationship to Participant ___________________________________________________________
Address _________________________________________________________________________
City __________________________State ____________________ Zip ______________________
Home Phone or TTY (717) __________________________________________________________
Work Phone (717) ________________________ Cellular Phone (717) _______________________
Work Phone (717) ________________________ Cellular Phone (717) _______________________
Emergency Contact (other than parent)
Home Phone or TTY (717) __________________________________________________________
Work Phone (717) ________________________ Cellular Phone (717) _______________________
Participant’s Weight _______________________ Height ___________________________________
Primary Disability __________________________________________________________________
________________________________________________________________________________
Secondary Disability _______________________________________________________________
________________________________________________________________________________
School/Agency ____________________________________________________________________
Allergies _________________________________________________________________________
________________________________________________________________________________
Medications ______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Major accidents or injuries in past years that could affect activity. ____________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________Does the participant need assistance with eating, toileting and/or dressing? Please explain, attach sheets as needed. _________________________________________________________________
________________________________________________________________________________
Does the participant have problems with communicating, behavior management, etc?Please describe and attach any current behavior management plans being used. _______________
________________________________________________________________________________
Is participant subject to seizures? Yes No
Yes No
(If yes, what type, frequency, duration, after care/rest needed)
________________________________________________________________________________
________________________________________________________________________________
Easterseals requests that the following information be updated yearly. The information form must be returned with the registration. Return the forms to Easterseals, Attention Therapeutic Recreation, 2550 Kingston Rd., Suite 219, York, PA 17402. Please remember to sign the second page of this form.
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Date: ______________________ Participant’s Name: _____________________________________
Signature: _________________________________________________________________________
Please Print Name: __________________________________________________________________(If under 18, parent/guardian signature)
Relationship to Participant: ____________________________________________________________
Participant Waiver - Easterseals Western and Central Pennsylvania is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. Easterseals continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/ guardians of minors registering for programs must recognize that there is inherent risk of injury when choosing to participate in recreational activities.
You are solely responsible for determining if you or your minor child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered any illness, injury or impairment, to consult a physician before undertaking any physical activity.
Warning of Risk - Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activities. Not all hazards and dangers can be foreseen. Participants must understand that certain risks, dangers and injuries due to acts of God, inclement weather, slipping, falling, equipment failure, failure in supervision, premises defects and all other circumstances inherent to recreational activities exist. In this regard, it must be recognized that it is impossible for Easterseals Western and Central PA to guarantee absolute safety.
Waiver and Release of All Claims and Assumption of Risk - Please read this form carefully and be aware that in signing up and participating in this program, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program (including transportation services, when provided). When registering by fax, it is understood that the facsimile registration document (including the waiver and release of all claims) shall substitute for and have the same legal effect as the original form.
Permission to Treat - In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by Easterseals Western and Central Pennsylvania to secure and administer treatment, including, but not limited to x-rays, hospitalization and surgical interventions. I also give permission to Easterseals Western and Central Pennsylvania to obtain related transportation.
I recognize and acknowledge that there are certain risks of physical injury to participants in this program, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program against Easterseals Western and Central Pennsylvania, including its officials, agents, volunteers and employees (hereinafter collectively referred as “Easterseals Western and Central Pennsylvania”).
I do hereby fully release and forever discharge Easterseals Western and Central Pennsylvania from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associate with this program.
Photos/Video Authorization and Consent - I hereby authorize and give my consent to Easterseals Western and Central Pennsylvania to photograph/video me or my child/ward, and without limitation, to use such photographs/video in connection with promoting/advertising the services, programs, and facilities of Easterseals Western and Central Pennsylvania without consideration of any kind. I understand that photos and/or video usage could include, among other outlets, Easterseals Western and Central Pennsylvania’s website, Facebook, and/or other social media outlets.
Personal Information Authorization Consent - I further authorize Easterseals Western and Central Pennsylvania to release personal contact information to other parents/participants when deemed appropriate including names, addresses and phone numbers. I have read and fully understand the above important information, warning and assumption of risk, waiver and release of all claims and photo/video and personal information authorization and consent and agree to all terms and conditions as set forth above.
Does the participant use a wheelchair? Yes No Manual _______ Electric _______
Does participant have Down Syndrome? Yes No
If yes, have x-rays of the vertebrae been taken? Yes No If yes, is participant clear of Atlantoaxial Dislocation Condition? Yes No – If yes, please attach copy of medical exam.
Has the participant or his/her parent/guardian served in the military (active duty, national guard, reserves, veteran)? Yes No
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We would Love for you tojoin Us!
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