Afterhours Registration

Experiencing the World (Mon, 3pm-6pm)
Come join us for a “trip” around the world. Sit back, relax, and experience the many cultures beyond our borders. Each week you will visit a different country by, tasting traditional snacks, dancing to music, and creating different types of crafts.
Monthly ($125)Quarterly ($375)


Bowling (Tues, 3pm-5pm)
Each week we will bowl one to two games at a bowling alley. Rolling Lanes Bowling Center in Countryside will be our primary site unless there is a conflict with their schedule; in that case we will go to another local bowling alley. Participants will need to bring $4 to play two games. (Currently it is $2.00 per game).

Monthly ($90)Quarterly ($270)


Bust-A-Move (Wed, 3pm-5pm)
Come learn all the cool dance moves and get a good workout!
Monthly ($80)Quarterly ($240)



Bust-A-Move (Thurs, 3pm-5pm)
Come learn all the cool dance moves and get a good workout!
Monthly ($80)Quarterly ($240)


Weekly Wildcard (Fri, 3pm-6pm)
Game on! Every Friday 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 ($115)Quarterly ($345)

*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
$