Register early before sessions reach max capacity! Adaptive Swim Clinics NEW Transportation Stops NEW Altitude Leadership and extended ages Can’t wait for summer? Spring sessions still available! 4 VIA WEST CAMPUS Proudly working with children, teens, and adults www.viaservices.org • 13851 Stevens Canyon Road, Cupertino, CA 95014 Tours available for new families. Please contact Katie Gilbreth 408-243-7861 x218 or [email protected]Employment and volunteer opportunities available. Please contact Jose Mosqueda 408-243-7861 x253 or [email protected]2018 Summer Programs
Transcript
Register early before sessions reach max
capacity!
Adaptive Swim
Clinics
NEW Transportation
Stops
NEW Altitude Leadership and extended ages
Can’t wait for summer?
Spring sessions
still available!
4
VIA WEST CAMPUS
Proudly working with children, teens, and adults www.viaservices.org • 13851 Stevens Canyon Road, Cupertino, CA 95014
Tours available for new families. Please contact Katie Gilbreth 408-243-7861 x218 or [email protected] and volunteer opportunities available. Please contact Jose Mosqueda 408-243-7861 x253 or [email protected]
Jose Mosqueda is the Staffing Manager for Via West and Altitude and is responsible for the recruitment of staff, supervision, and management of all Via West Campus needs.
Jennifer Bui is a Kitchen Manager for Via West and is responsible for executing the preparation and service of all planned meals for participants and staff.
Anthony Zeppa is a Kitchen Manager for Via West and is responsible for executing the preparation and service of all planned meals for participants and staff.
Shama Marshall is the Director of Altitude and is responsible for the intake process of new participants, managing the sessions, and preparing the wonderful curriculum for Altitude Programs.
Katie Gilbreth is the Community Relations Manager and is responsible for bringing all new families to Via West and Altitude as well as recruiting for our special needs science camps.
Staff
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4 Dear Families, Friends, and Supporters,
Via Services is proud to present the 2018 Via West Summer Program Registration Catalog. We are so excited to offer sessions for every age group in every single month this upcoming summer.
We will be offering our traditional day and overnight programs, an adults bridge session, Adventures in Leadership, Altitude programs, and adaptive swim
clinics. Our diverse sessions offer something for everyone, and as always, we make every effort to ensure that your participant has a life-changing experience at Via.
In addition to all of the Via West staples that you have come to expect and enjoy, we have some new changes and additions. First, to meet the growing needs of our participants, our management team has expanded to include the Associate Director of Programs and Grants, Staffing Manager, and Operations Manager. Second, we are so thrilled to announce the renovation of the Via West amphitheater is nearing completion, and your participant will be able to enjoy the benefits this summer. Third, we have reconstructed our lodges to provide individual rooms, for a nominal cost, for those participants that need more privacy during bedtime. Lastly, we are expanding our transportation services to Santa Clara, Palo Alto, Fremont, and Santa Rosa.
At Via West, we welcome everyone with open arms. We have a scholarship fund available for those who cannot afford our private pay or regional center (RC) supplemental daily rates. We are so fortunate to work with you, our families, and we hope that you continue to make Via your home away from home.
Thank you for continuing to spread the word about Via West Campus. Without you, we would be the Bay Area’s best kept secret. See you all very soon!
Sincerely,
Irshad Fardan Director, Via West
Chelsea Farrington is the Associate Director of Programs and Grants for Via West and is responsible for co-managing the sessions, preparing the wonderful curriculum, and coordinating the grants.
Gray Davis is the Operations Manager and is responsible for the supervision and management of all Via West needs and logistics.
SUMMER PROGRAM DESCRIPTIONSAll of our sessions are supported by a number of generous grants, including those from the Sobrato Family Foundation, Mentor Graphics Foundation, Leo M. Shortino Family Foundation, Farrington Historical Foundation, Western Digital Foundation, MENTOR Charitable Network, the Santa Clara County Realtors Foundation, and the Sharks Foundation. We would like to extend our gratitude to these wonderful organizations for their continued support of Via West and Altitude.
Traditional Day & Overnight Programs (Adults) Traditional Day & Overnight Programs (Kids/Teens/Young Adults)Traditional day and overnight programs provide independent living skills and executive functioning, all while having so much fun. The sessions vary in length and start date,
giving participants, parents, and caregivers the opportunity to select programs that match their interests and lifestyles. Activities will be themed to each session and will include culinary arts — including farm-to-table education, hiking, music, sports and physical fitness, dramatic arts, creative arts, and more. For overnights, check-in times will be from 10:00am-12:00pm on the first day and check-out times will run from 1:00-3:00pm on the last day. Every session has the option to select day programs, which will run from 9:00am-8:00pm every day of the program with the exception of the first and last days, when the schedule will be abbreviated.
Adventures in LeadershipLeadership programs are for 3:1 adults with developmental and/or physical disabilities who are ready to master relevant knowledge, skills, and attitudes for working at Via West in preparation for community work settings. Participants will engage in some of the typical camp activities as well as leadership-specific activities wherein they will work on these specific skills. To enroll in Beginning Adventures in Leadership, participants must have completed at least two summer and/or weekend sessions within the past five years. To enroll in More Adventures in Leadership, participants must have completed at least one of the Beginning Adventures in Leadership programs. To enroll in Continuing Adventures in Leadership, participants must have completed both Beginning Adventures in Leadership and More Adventures in Leadership. Leadership sessions run concurrently with select traditional overnight programs. Check-in times will be from 10:00am-12:00pm on the first day and check-out times will run from 1:00-3:00pm on the last day.
AltitudeAltitude is for participants who can function in a 3:1 ratio, have conversational language skills, are not currently struggling with any significant behavioral challenges, and are
typically in a mainstream classroom setting. Check-in times for Sleep-Away will be from 9:00-11:00am on the first day and check-out times will run from 10:00am-12:00pm on the last day. Check-in times for Getaway will be from 9:00-11:00am on the first day and check-out times will run from 10:00am-12:00pm on the last day. Extended Day Program and Mini Altitude Day Program run from 9:00am-8:00pm each day.
Adaptive Swim ClinicsWith financial support from Autism Speaks, we are proud to offer Adaptive Swim Lessons for children, teens, and adults during select summer Via West sessions. Each clinic is comprised of 4 sessions that begin at 9:30am and run for 45 minutes.
7-day May 31-June 6, 2018 (THUR-WED) 3-day June 1-3, 2018 (FRI-SUN)Bonjour et bienvenue à Disney! Join us as we “journey” overseas to explore all of the fun that is Euro Disney. Everyone will get to ride horses like Flynn Rider, learn archery like Robin Hood, and bake ratatouille like Remy. Our field trips include a fun jaunt down to Little Italy as well as a day in San Francisco exploring The Walt Disney Family Museum and having fun on the beach. We’ll compete in a nighttime soccer tournament, and everyone will make and take home Eiffel towers, Mickey Mouse ears, stained glass art, and more!Field Trips: Little Italy (June 4), San Francisco (June 5)
Adults ages 18+SURF, SUN, AND FUN! BEGINNING ADVENTURES IN LEADERSHIP5-day June 15-19, 2018 (FRI-TUES) 3-day June 15-17, 2018 (FRI-SUN)Who’s ready to hang ten? This week is all about adventures in the sun and sea! Let’s learn about whales, sharks, and more during our field trip to the Seymour Marine Discovery Center. All campers will get to create an ocean in a bottle, surfboard, whale craft, and more! Sunshine abounds as we ride horses, make footprints in the sand, learn about hydroponic gardening, and grill up some delicious vegetable kabobs. Of course, we’ll also spend plenty of time “surfing” in the Via West pools.Field Trip: Seymour Marine Discovery Center (June 18)
Since Surf, Sun, and Fun falls on the heels of Scooby Doo: Where Are You, you have the opportunity to bridge the two sessions together by staying on Campus on June 19th! For pricing on the extra day, please see page 11.
Adults ages 18+SCOOBY DOO: WHERE ARE YOU? ADAPTIVE SWIM CLINIC 6/21, 6/22, 6/23, 6/24 at 9:30AM
5-day June 20-24, 2018 (WED-SUN) 3-day June 22-24, 2018 (FRI-SUN)Ruh-roh Shaggy, we have a real mystery on our hands here! Scooby Doo has gone missing and it’s up to us to find him! First, let’s try to lure him out by making some Shaggy submarine sandwiches, and if that doesn’t work, then some Scooby Snacks. We’ll search for clues on a scavenger hunt throughout campus and on our night hike — watch out for ghosts! Zoinks — our field trip to the Mystery Spot in Santa Cruz takes us even deeper into the unknown. Back on campus, everyone will craft mystery machine lunchboxes, character puppets, dog collar bracelets, and more!Field Trip: Santa Cruz (June 21)
Adults ages 18+READY, SET, ACTION: MOVIE MANIAMORE ADVENTURES IN LEADERSHIP
3-day July 6-8, 2018 (FRI-SUN)Who’s ready to be a star? This special movie-themed session will put you right in the middle of the action, starting with a field trip to go see the summer’s hottest blockbuster in the theater. Back on campus, we’ll train to be in the Matrix movies, bake yummy Back to the Future-inspired pizzas, and put on our very own Via West show. The take-home projects for this weekend include a make-your-own Hollywood star, dazzling microphone, and more!Field Trip: Movie Theater (July 7)
Adults ages 18+GAME SHOW GETAWAYCONTINUING ADVENTURES IN LEADERSHIP 5-day August 15-19, 2018 (WED-SUN) 3-day August 17-19, 2018 (FRI-SUN)Come on down! You’re the next contestant on our Game Show Getaway! Our last session of the summer is full of crazy game show hijinks. All of the classics will be played – Family Feud, Price is Right, and Jeopardy, to name a few. We’ll also ride horses, host a Jokers wild casino night, and laugh out loud on our field trip to ComedySportz San Jose. Does anyone want to buy a vowel as we bake Wheel of Fortune fruit tarts or guess the mystery word when we build $100,000 Pyramid sandcastles? Survey says….what a way to end the summer!Field Trip: ComedySportz San Jose (August 16)
ids/Teens/Young Adults)Kids, Teens, and Young Adults ages 5-22UNDER THE BIG TOP 5-day June 8-12, 2018 (FRI-TUES) 3-day June 8-10, 2018 (FRI-SUN)
Ladies and gentlemen, boys, and girls, children of all ages, welcome to the greatest show on earth! That’s right! The Via West circus is in town and it’s got clown costume relay races, horseback riding, pool acrobatics, and a trip to the San Mateo County Fair. We’re
going to make milk jug elephants, lion masks, and some scrumptious mini corn dog muffins. The week wouldn’t be complete without our very own Via West Carnival full of sno-cones, cotton candy, a bounce house, and games galore!Field Trip: San Mateo County Fair (June 11)
Kids, Teens, and Young Adults ages 5-22A TRIP AROUND THE U.S.A.ADAPTIVE SWIM CLINIC 6/28, 6/29, 7/1, 7/3 at 9:30AM
7-day June 27-July 3, 2018 (WED-TUES) 3-day June 29-July 1, 2018 (FRI-SUN)It’s our annual Fourth of July celebration at Via West! This all-American session has tons of fun, patriotic activities like fireworks art, bald eagle crafts, Statue of Liberty models,
and some friendly games of baseball. Everyone will get to make and enjoy red, white, and blue fruit kabobs, and of course, down-home apple pie. We have two amazing field trips to BBQ by the lake and to watch the Oakland A’s take on the Cleveland Indians. Let’s go A’s!Field Trips: Oakland A’s (June 30) Lake (July 2)
Kids, Teens, and Young Adults ages 5-22VIA WEST PRESENTS THE BEST OF DISNEY 5-day July 11-15, 2018 (WED-SUN) 3-day July 13-15, 2018 (FRI-SUN)A dream is a wish your heart makes, and we dreamed that it was Disney week at Via West! Let’s ride horses like Merida, swim in the pool like Ariel, and search for pirate treasure like Peter Pan. Who wants to design their very own Disney castle, Heart of Te Fiti necklace, and Lightning McQueen license plate? After enjoying some thrilling rides and yummy food at the Santa Cruz Beach Boardwalk, we’ll come back to campus and bake Lady and the Tramp spaghetti and meatballs.Field Trip: Santa Cruz Beach Boardwalk (July 12)
Kids, Teens, and Young Adults ages 5-22ADVENTURE IN AFRICA: A SAFARI TO REMEMBERADAPTIVE SWIM CLINIC 8/3, 8/4, 8/5, 8/6 at 9:30AM
7-day July 31-August 6, 2018 (TUES-MON) 3-day August 3-5, 2018 (FRI-SUN)Jambo! We’re so excited you could join us on our African safari adventure! Jungle animals are everywhere this week, and we’ll get up close and personal with them at the Oakland Zoo and at the exotic animal live show on campus. After another fun field trip to Golfland, we’ll ride horses and bake some tasty banana pancakes. Our creative side will show with fun projects like homemade African drums, sunset pictures, and African animal masks.Field Trips: Oakland Zoo (August 1) Golfland (August 2)
Kids, Teens, and Young Adults ages 5-22HARRY POTTER & FANTASTIC BEASTS5-day August 8-12, 2018 (WED-SUN) 3-day August 10-12, 2018 (FRI-SUN)Dear Mr. Potter, you have been accepted into Hogwarts School of Witchcraft and Wizardry. Join Harry, Ron, and Hermione on an epic wizarding adventure! After being sorted into our houses, we’ll take a field trip to see some truly fantastic beasts at the Marine Mammal Center in Sausalito. The rest of the week includes playing in an exciting Quidditch match, baking Kreacher’s famous cinnamon rolls, potting Mandrakes, and creating fun take-homes like niffler ceramics, magic wands, and golden snitches.Field Trip: Marine Mammal Center (August 9)
Altitude offers summer camp experiences for boys and girls with social cognitive challenges including verbal and nonverbal learning disabilities, ADHD, Asperger’s, and high functioning autism. Altitude is a place where participants build social skills, independence, and self-confidence. We offer a fun summer vacation where friendships are developed. With warmth, guidance, and ongoing support, we prepare our participants for the transition to young adulthood, future relationships, and the rest of their lives!The Altitude participant has back-and-forth conversational skills, is not currently struggling with any significant behavioral challenges, and is typically independent within a mainstream classroom setting. Our intake process involves a face-to-face interview with each prospective participant, and we will also check two references — these are professionals whom the family trusts and are often teachers and therapists. The process from application to acceptance can take 2 to 5 weeks, depending on availability of references and scheduling of interviews. Altitude is intentionally designed to facilitate and prepare our campers for key developmental transitions, between elementary, middle, and high school. These pivotal times are characterized by new opportunities, as well as increased academic, social, and emotional demands.
We aim to help our participants prepare for this journey by providing them with a warm, understanding, fun, and supportive learning environment where they will grow socially and emotionally and build self-esteem.Altitude offers a 3:1 staff-to-participant ratio, as well as the presence of a “Clinical Team” available to gently guide our participants through the camp experience. Our participants learn through an organic process, in which our staff recognizes significant learning opportunities while the participants engage in fun, traditional camp activities such as swimming, athletics, art, drama, and more.
Youth entering 5th through 12th gradeSLEEP-AWAY — FULL OVERNIGHT
12-day July 18-29, 2018 (WED-SUN)Altitude offers a 12-day overnight summer camp experience for youth with social cognitive challenges including verbal and nonverbal learning disabilities, ADHD, Asperger’s, and high functioning autism. Altitude is a place where participants build social skills, independence, and self-confidence. We offer a fun summer vacation where friendships are developed. With warmth, guidance, and ongoing support, we prepare our participants for the transition to young adulthood, future relationships, and the rest of their lives!
Youth ages 16-20LEADERSHIP — OVERNIGHT
12-day July 18-29, 2018 (WED-SUN)Leadership participants will get all of the fun of camp while learning valuable organizational and mentorship skills. Activities will include planning outings, preparing and serving meals, assisting in leading on-campus activities, creating exciting evening campfire rotations, running the Altitude store, etc. Participants will have the opportunity for additional monitored socialization opportunities in the evening as well. Please inquire for availability of this program as space is limited. This program is available to returning participants only — a participant must have attended a minimum of a weekend session for eligibility.
Youth entering 5th through 12th gradeGETAWAY — OVERNIGHT6-day July 24-29, 2018 (TUES-SUN)Getaway is an abbreviated overnight experience for those who are not quite ready for the full 12 days. This 6-day, 5- night stay on campus allows for friendships to be developed. With warmth, guidance, and ongoing support, we prepare our participants for the transition to young adulthood, future relationships, and the rest of their lives!
Youth entering 3rd through 12th gradeEXTENDED DAY PROGRAM
10-day July 19-28, 2018 (THUR-SAT)Extended Day Program provides participants with a day option from 9:00am-8:00pm for those who want the opportunity to experience the “Altitude Attitude” without having to stay overnight. We are excited to expand this program to include children entering 3rd and 4th grade.
Youth entering 3rd through 12th gradeMINI ALTITUDE — DAY PROGRAM5-day July 23-27, 2018 (MON-FRI)Mini Altitude provides participants with an opportunity to engage in the Altitude experience on a smaller scale with M-F day camps from 9:00am-8:00pm. Participants will engage in the same activities as our Sleep-Away participants while building important life-skills in a naturalistic setting. We are excited to expand this program to include children entering 3rd and 4th grade.
We are so excited to expand our transportation offerings to now include 9 locations across the Bay Area. All vans will have both a Senior Via West Counselor and Nurse on board. 1:1 participants will have their assigned counselor riding with them. Check-in will occur with both the counseling staff as well as the nursing staff. Special diet information will be given to the nursing staff as well. Remaining payments and paperwork, if any, will need to be rendered at the designated check-in location. It is very important that parents bring all packing list items as you would if you were bringing the participant to the campus directly. None of the processes will change. It will be the parent/caregiver’s responsibility to ensure that the participant is changed and fed as the ride may be up to 90 minutes depending on location and traffic.
We will be providing transportation for $75.00 each way
from San Jose, Santa Clara, Palo Alto, and Fremont. We will also provide transportation for a distance rate of $100.00 each way from South San Francisco, Oakland, Santa Rosa, Salinas, and Santa Cruz. All pickups for check-in days will occur between 10:30am-12:00pm, and your specific pickup time will be prearranged and discussed with you prior to check-in day. Drop off times will be between 12:00pm-1:30pm and will also be prearranged ahead of time.
Our vans will remain at the designated locations for 20 minutes after the pickup and drop off time frames before leaving to return to Via West Campus. If you miss your scheduled pickup or drop off time, you will be charged a fee of $100. If you miss your drop off time, you will need to pick your participant up from Via West Campus where our regular late pickup policy will be in effect.
Day and Overnight Programs
Adults Ages 18+ February 9-11, 2018 (FRI-SUN) GUARDIANS OF THE GALAXY
March 2-4, 2018 (FRI-SUN) PIRATES AND PRINCESSES
March 23-25, 2018 (FRI-SUN) TIME TRAVEL THROUGH THE DECADES
April 20-22, 2018 (FRI-SUN) STREETS OF SF
May 4-6, 2018 (FRI-SUN)SOUTH OF THE BORDER
Kids, Teens, Young Adults Ages 5-22January 19-21, 2018 (FRI-SUN) WALK AMONGST DINOSAURS
February 16-19, 2018 (FRI-MON) POWER RANGERS
March 9-11, 2018 (FRI-SUN) CLASH, CLASH, BANG!
April 6-8, 2018 (FRI-SUN) WHERE THE WILD THINGS ARE
April 27-29, 2018 (FRI-SUN) BEETLES, BUGS, AND BUTTERFLIES
May 18-20, 2018 (FRI-SUN) UNDER THE SEA
Older Teens and Young Adults Ages 16-48January 26-28, 2018JUMANJI: VIA WEST STYLE
Travel Camp:
Kids, Teens, Young Adults Ages 5-22February 9-11, 2018 (FRI-SUN) HEADING TO HOLLYWOOD
Adventures in Leadership
Adults ages 18+January 26-28, 2018 (FRI-SUN) CONTINUING ADVENTURES IN LEADERSHIP
February 9-11, 2018 (FRI-SUN) BEGINNING ADVENTURES IN LEADERSHIP
March 2-4, 2018 (FRI-SUN)MORE ADVENTURES IN LEADERSHIP
March 23-25, 2018 (FRI-SUN)CONTINUING ADVENTURES IN LEADERSHIP
AltitudeKids and teens entering 4th-12th gradeFebruary 9-11, 2018 (FRI-SUN) HEADING TO HOLLYWOOD TRAVEL CAMP
Entering 4th to 11th gradeApril 13-15, 2018 (FRI-SUN) A TASTE OF ALTITUDE
Spring ProgramsSpring Programs STILL OPEN FOR REGISTRATION – Contact the admissions department for more information or to register. If you would like detailed descriptions of the all of the fun and learning that each session has to offer, please visit our website www.viaservices.org to view the full 2017-2018 Fall, Winter, and Spring Programs Brochure.
Come join us at the 6th annual Fall Festival at Via West Campus. Entrance will again be free, and tickets will be available to purchase to use towards delicious food and fun and games. Back by popular demand will be the haunted house, pumpkin patch, petting zoo,
and much more! For more information, please visit www.viaservices.org
Saturday, October 13, 2018 • 11am–3pm
presents the 6th Annual
Spec
ial E
vent
s
ViaPoker
TournamentPoker Tournament
May 3, 2018All of the proceeds will directly benefit the
programs of Altitude, First Step, and Via West. For more information, please visit www.viaservices.org
Via Services will host its 2nd annual
23rd Annual Via Ball February 24, 2018
A Great Gatsby Gala at Villa Ragusa in downtown Campbell
100% of the proceeds will directly benefit the programs of Altitude, First Step, and Via West.
For sponsorship information or to purchase tickets, visit www.viaservices.org
2851 Park Ave., Santa Clara, CA 95050 • (408) 243-7861 www.viaservices.org
Dr. Joe CironeSandi ConniffJohn W. (Jack) EasterbrookTodd Goldman
David GriffyJohn HeagertyDean MunroScott PaineEric Seymour
Vince SunzeriJames TobyKathryn Wise
About Via ServicesFormerly the Crippled Children’s Society, Via Services has been serving the Bay Area and beyond since 1945. Via is a private, independent non-profit dedicated to helping children and adults with disabilities and special needs achieve greater self-sufficiency and lead richer lives through three programs:
FIRST STEP provides play-based speech and occupational therapy, as well as Early Start assessments to children.
VIA WEST provides year-round residential respite care with special needs camping programs to children and adults.
ALTITUDE provides year-round camping experiences for kids and teens with social cognitive challenges.
4REGISTRATION DEPOSIT FORMReturn to Via Services, Inc. Mailing address: 2851 Park Ave, Santa Clara, CA 95050 Attn. Via West Manager • Phone: 408-243-7861 • Fax: 408-243-0452
Please make a copy for your records, and mail in the following forms to register.
PARTICIPANT’S NAME PARENT/GUARDIAN NAME
NUMBER OF VIA WEST SESSIONS SELECTED X $100 OR
$984 ALTITUDE FULL OVERNIGHT OR LEADERSHIP $820 ALTITUDE EXTENDED DAY $492 ALTITUDE GETAWAY
$410 MINI ALTITUDE
REGISTRATION DEPOSIT TOTAL $
PAYMENT DATE: PAYMENT AMOUNT:
PAYMENT TYPE: VISA MASTERCARD AMEX CASH CHECK NO.
CARDHOLDER NAME CONTACT PHONE NUMBER
CARD NUMBER CARD EXPIRATION DATE SECURITY CODE
PROMO CODE
Please note that your registration will not be processed without the registration deposit (per session). We strongly encourage you to register online. However, if necessary, we will accept your registration by mail or email with the appropriate registration deposit.
Please note that the deposit will be applied to the balance of your program regardless of payment method.
In planning for each participant’s stay at Via West and Altitude, costs are incurred in advance. Therefore, if you cancel within 31 days of your scheduled session, for whatever reason, your registration deposit will be retained to help cover lost expenses. I have read and understood the policies regarding the Registration Deposit.
SIGNATURE DATE
✃
Scholarship money is greatly needed. Help someone like David attend Via West! Help a family in need send their child/adult to THEIR favorite week of the year.
(Check one) Please charge this amount to my credit card above I have enclosed a check in this amount.
Meet 31-year-old David. He has been coming to Via West with the help of scholarships since 2016. His mom writes “Camp is the best thing to happen to David in a long time. The counselors challenge him and let him be who he is. It’s the highlight of his month.” Without our scholarship fund, David would not be able to attend his favorite week of the year.
I would like to request an individual room for $40/night for my participant’s overnight session(s).Please note that this does not guarantee an individual room. Private rooms are first come, first served.TRANSPORTATION Pick Up Drop Off Round Trip Locations: San Jose Santa Clara Palo Alto Fremont South San Francisco Oakland Santa Rosa Salinas Santa Cruz
ON= Overnight PP= Private Pay RC= Regional Center
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SUMMER 2018 REGISTRATION FORMReturn to Via Services, Inc. Mailing address: 2851 Park Ave. • Santa Clara, CA 95050 • Attn: Via West Manager Phone: 408-243-7861 • Fax: 408-243-0452
WHICH REGIONAL CENTER PROVIDES YOUR FUNDING?
PARTICIPANT’S LAST NAME FIRST NAME MIDDLE
AGE BIRTHDATE GENDER PARENT/LEGAL GUARDIAN NAME
TELEPHONE EMAIL ADDRESS
WHAT IS THE PARTICIPANT’S RATIO? 1:1 2:1 3:1 UNCERTAIN
I WOULD LIKE TO REGISTER MY PARTICIPANT FOR THE FOLLOWING SESSION(S):Please check the session(s) below, and indicate how the session will be funded. For the day only option, please check the box next to each day that you are requesting for your participant to attend.
Via West Adults (18+) Traditional Day and Overnight Programs May 31-June 6 OR June 1-3Euro Disney PP RC 7-Day ON 3-Day ON DAY OPTION ONLY: 5/31 6/1 6/2 6/3 6/4 6/5 6/6
June 15-19 OR June 15-17 Surf, Sun & Fun PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 6/15 6/16 6/17 6/18 6/19
June 19 Bridge Day PP
June 20-24 OR June 22-24 Scooby Doo PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 6/20 6/21 6/22 6/23 6/24
July 6-8 Movie Mania PP RC 3-Day ON DAY OPTION ONLY: 7/6 7/7 7/8
August 15-19 OR August 17-19 Game Show PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 8/15 8/16 8/17 8/18 8/19
Via West Kids, Teens, Young Adults (5–22) Traditional Day and Overnight ProgramsJune 8-12 OR June 8-10 Under the Big Top PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 6/8 6/9 6/10 6/11 6/12
June 27-July 3 OR June 29-July 1 Trip Around USA PP RC 7-Day ON 3-Day ON DAY OPTION ONLY: 6/27 6/28 6/29 6/30 7/1 7/2 7/3
July 11-15 OR July 13-15 Best of Disney PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 7/11 7/12 7/13 7/14 7/15
July 31-August 6 OR August 3-5 Adventure in Africa PP RC 7-Day ON 3-Day ON DAY OPTION ONLY: 7/31 8/1 8/2 8/3 8/4 8/5 8/6
August 8-12 OR August 10-12 Harry Potter PP RC 5-Day ON 3-Day ON DAY OPTION ONLY: 8/8 8/9 8/10 8/11 8/12
Via West Adults (18+) Adventures in Leadership June 15-19: Beginning Adventures PP RC
July 6-8: More Adventures PP RC
August 15-19: Continuing Adventures PP RC
Altitude July 18-29 Full Overnight Entering 5th-12th Grade
July 18-29 LeadershipAges 16-20
July 24-29 Getaway Entering 5th-12th Grade
July 19-28 Extended DayEntering 3rd-12th Grade
July 23-27 Mini Altitude DayEntering 3rd-12th Grade
Price includes nursing, education/respite fun, 3 meals a day, snacks, all scheduled program activities, field trips and transportation (when applicable).
Price includes nursing, education/respite fun, 3 meals a day, snacks, all scheduled program activities, field trips and transportation.
DAY PROGRAMS9am through 8pm $205 $245 $290
BRIDGE DAY (For SURF, SUN, AND FUN!) JUNE 19Private Pay only $150 $175 $200
ADAPTIVE SWIM CLINIC Private Pay only $80 $80 $80
TRANSPORTATION $75 each way from San Jose, Santa Clara, Palo Alto, Fremont$100 each way from South San Francisco, Oakland, Santa Rosa, Salinas, Santa Cruz
ALTITUDE FULL OVERNIGHT AND LEADERSHIP July 18-29 $3,888$984 registration deposit, refundable until 31 days before start date
ALTITUDE GETAWAY July 24-29 $1,944 $492 registration deposit, refundable until 31 days before start date
ALTITUDE EXTENDED DAY July 19-28 $2,050 $820 registration deposit, refundable until 31 days before start date
MINI ALTITUDE DAY July 23-27 $1,025$410 registration deposit, refundable until 31 days before start date
INDIVIDUAL ROOM Private pay only.Based on availability. First come, first served. $40/night $40/night $40/night
REGISTRATION PROCEDURES:Registration is now open for all summer programs. We are not restricting any spaces in our regular programs, however we do still have a maximum capacity. Spaces are available on a first come, first served basis with deposit to secure reservation. We strongly encourage you to register online. However, if necessary, we will accept your registration by mail or email. We encourage attendance at multiple sessions as our enhanced thematic programming will be very different each session. If you do not have 8 hours from the Regional Center for the day programs, you will be charged at the private pay rate. In order for your participant to be marked down as paid, we require:1. An Authorization to Purchase Services to be sent to the Via office before the start date of the session.2. The payment of the private pay or supplemental daily rate in full.If payment is not received from the regional center as authorized, you will be responsible for the remainder of the payment due at the private pay rate.
PRIVATE PAY PRICING
REGIONAL CENTER SUPPLEMENTAL DAILY RATE PRICE SHEET This mandatory rate is paid in full by the parent/caregiver in addition to what is funded by the regional center.
