Afterhours Registration

Weekly Wild Card (Mon, 3pm-6pm)
Game on! Every Monday afternoon our participants will enjoy a day of socialization through a variety of games. The group will experience friendly competition and fun through board games, video games, sports and other activities.
Monthly ($135)Quarterly ($405)


Bowling (Tues, 3pm-5pm)
Bowl your way into summer! Come join us for some socialization and friendly competition. Each week we will bowl at a local bowling alley. Make sure you bring #4 for two games.
Cost of bowling is not included in the fee.
Monthly ($113)Quarterly ($339)


Movin' & Grovin' (Wed, 3pm-5pm)
Come get a total body workout! In this group you will be doing both strength training and cardio fitness. We will utilize a mix of free weights, resistance bands, steppers and staionary bikes along with walking and dancing. This program is suited for a beginner to a fitness fanatic - as YOU set your own bar for how far you want to push!
Monthly ($113)Quarterly ($339)


Bust-A-Move (Thurs, 3pm-5pm)
Join us as we learn different movements that will reduce our stress, increase self-expression all while having fun. Each week we will play different music, learn different movements and get tips on how to reduce stress.
Monthly ($113)Quarterly ($339)


Social Club (Fri, 3pm-6pm)
Start the weekend fun with us! Each week you will explore different places within your community. In this program, you will visit parks, restaurants, and shops. Cost of food and admissions are not included in the fee.
Monthly ($162)Quarterly ($486)

*Participant Name

MaleFemale

*Address

*City, State

*Zip

*Disability

Is participant prone to seizures?YesNo

Does participant use wheelchair/walker?YesNo

List allergies

List medications

Does participant have a communicable disease?YesNo

If yes, please explain

*Primary Emergency Contact Person

Relation

*Primary Phone

Secondary Phone

*Email Address

Secondary Emergency Contact Person

Relation

Primary Phone

Secondary Phone

Email Address

Funding Source
ICILAHome-BasedPrivate Pay

*Total Amount Due
$