All Aboard Participant Application

Caregiver / Emergency Contact #1

This contact information should be someone who lives with the participant.
Caregiver's Name

First NameLast Name
Relationship to Participant
i.e. Parent, Guardian, Caregiver, Sibling, etc.
Caregiver's Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Caregiver's Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Caregiver's Email
example@example.com

Emergency Contact #2
Emergency Contact Name

First NameLast Name
Relationship to Participant
i.e. Parent, Guardian, Caregiver, Sibling, etc.
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact #3
Emergency Contact Name

First NameLast Name
Relationship to Participant
i.e. Parent, Guardian, Caregiver, Sibling, etc.
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Participant Health Information

While none of the All Aboard staff are medical providers, we strive to protect our participants' health as best we can. We are not responsible for diet restrictions. Please send appropriate snacks if medically necessary. We will do our best to accommodate when possible. Please provide detailed responses in this section in case it's needed for emergency responders. If the answer does not apply, type in either "NA" (Not Applicable) or leave blank. We have taken steps to ensure that the information entered into this form is secure and HIPAA compliant.
Mobility needs:
Will a caregiver be attending with the participant? (We do not charge extra for this - just trying to assess capacity of our building)
Allergies or Serious Reactions:
Medical Conditions (e.g. seizures/epilepsy, Down Syndrome, diabetes, asthma, heart conditions, etc.)
Communication accommodations (ASL, hearing aids, etc.):
Participant behaviors of which staff should be aware:
Are there any particular triggers to the above behaviors?
What interventions or strategies do you recommend to help the participant in those situations?
Any additional information about the participant that would improve the quality of their experience at All Aboard:

Who is All Aboard of America 1 ("All Aboard")?

All Aboard is an activities program for adults with special needs. Our mission is to provide recreational, social, and educational activities for adults with special needs and help them develop an active, positive, and inclusive lifestyle. Because All Aboard is an activities center only, we do not provide medical care. If a participant requires assistance with eating, using the restroom, or taking medication, then a caregiver must attend All Aboard with the Participant. All Aboard staff will not administer medication and will only assist in the restrooms in case of emergency.
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AUTHORIZATION OF SERVICES
1. Participants will only be charged for sessions attended. If a participant is present for at least 60 minutes of a session, they will be charged for the entire session.
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2. We offer a morning session from 9am-noon. Drop-off for morning sessions is between 8:30am and 9am and pick-up for morning sessions is between noon and 12:30pm.
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3. We offer an afternoon session from 12:00-3:00pm. Drop-off for afternoon sessions is between 11:30 and 12pm, and pick-up for afternoon sessions is between 3:00pm-3:30pm.
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4. Drop off (before 11:30 AM) and Pickup (after 12:30 PM and after 3:30 PM for afternoon sessions) will be charged $25 per 15 minutes. Drop off before 11am for the afternoon session will be charged for a full day session.
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5. The cost per 3-hour session is $55.00. There are financial resources available on All Aboard’s website if needed.
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6. Attendance will be taken by computer and paper for each session.

Unique QR codes are used to scan in attendance and scan out attendance. We also have cameras set up throughout the space which help verify attendance.
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7. A participant will not be released to someone who is not their parent/guardian, or is not listed above ("Who has permission to pick up the Participant?" in Section 1 of this form), unless it is DART or PARA transit and the participant's name is on the official roster.
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8. If there is a change in attendance, it is the care provider's responsibility to contact DART or PARA to cancel the participant's ride.
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9. I authorize All Aboard of America 1 day program to bill for services provided to my participant (named above) and to receive payment from DDA if the member has Respite funding to apply to day program session fees. I understand that Respite hours need to be pre-authorized by the case manager and will be billed monthly. I understand it is my responsibility to confirm that funding is available to cover the cost of this program prior to each month and if Respite funding is exhausted I will be billed at the private pay rate.
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10. Unpaid balances on accounts (30 days after date of invoice) will incur a $35 late fee on the invoice. We reserve the right to refuse service to participants that have unpaid bills over 30 days.
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Food Allergies

All Aboard staff will do their best to prevent participants with allergies from ingesting foods they are allergic to. All Aboard may not be able to prevent ingestion for participants with allergies at all times. If your participant has a severe allergy, it is best that a caregiver attend All Aboard with them.
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Snacks and Lunches

All snack and lunch times are monitored by staff members. Lunch time is 12-12:30. Healthy snacks are passed around by staff at 10:30am and 2pm daily at no extra charge. 1. If a participant intends to stay at All Aboard for the entire day (both sessions), they will be required to bring an appropriate lunch each day (limited in sugar and caffeine). If a participant is staying for the full day and does not bring a lunch, a lunch may be provided and charged $5 to the participant's account. 2. We don't provide refrigeration for packed lunches and snacks, but a microwave is available. 3. The "Snack Tavern" is open daily and offers snacks for purchase. Items vary and are based upon requests of the participants (up to 2 requests each). There are also a few lunch items like different flavors of Cup of Noodles. Most snacks are $1.00 each.
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Suspension

If a participant is sent to All Aboard when they have been suspended, have been notified that they may not attend due to causing disruption to our activities, or have an unpaid bill older than 30 days, the caregiver will be called to pick the participant up and they must be picked up within ONE hour. After one hour, if the participant has not been picked up, All Aboard will charge $75 per hour until they are picked up. A report may be made to DSHS depending on the situation.
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Items Lost

Expensive items should not be brought to All Aboard as staff will not be held responsible for their loss. Unidentified items that are found will be held in our "Lost and Found" for up to 30 days.
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Participant Requirements

1. All Aboard reserves the right to remove a participant if he/she poses a safety threat to staff members or other participants. 2. All participants must be at least 18 years of age and be able to feed themselves and care for themselves while in the restroom. All Aboard DOES NOT provide individual assistance with feeding or in the restroom. Repeated need for assistance will require the participant to bring a parent/guardian/caregiver with them while attending All Aboard. 3. All participants must annually update registration and emergency contact information when requested. 4. Participants must abide by All Aboard rules and follow the directions of instructors.
Initial here to indicate that you have read and understood the above
Emergency and Safety

1. Once per quarter, a mock fire drill will be performed so all participants are familiar with the procedure and exit strategies. 2. Staff will bring all participants to designated safe areas outside the building until the problem is resolved. 3. Staff will call caregivers of each participant present for pick up once it is safe to do so.
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Participant Illness

If a participant is ill, All Aboard staff will call the Emergency Contacts (listed in Section 2 of this form) to come pick up the participant. Please note that emergency contacts are required in order for your participant to attend. If requested by All Aboard, the participant must be picked up within ONE HOUR. If the participant has not been picked up within one hour, All Aboard will charge a fee of $75 per hour for isolation care. In the event of a serious illness or injury, if the Emergency Contacts cannot be reached in time, the participant may be transported to the nearest hospital for immediate care and treatment. Please report contagious conditions to the All Aboard office staff when they occur. We reserve the right to require a note from a healthcare provider prior to the participant's return. A participant should stay home at the first sign of a communicable disease. By doing so, you are protecting the All Aboard community from exposure to the illness. Signs a participant should stay home: 1. FEVER: A participant should remain at home if they have a fever higher than 100.4 degrees Fahrenheit (the CDC considers a person to have a fever at that temperature. The participant may return to All Aboard after they have maintained a normal temperature (between 97 and 100.3 degrees F) for at least 24 hours without the use of fever-reducing medicine (such as Tylenol or Motrin). 2. VOMITING: If a participant has vomited in the last 24 hours, they should not be sent to All Aboard. 3. DIARRHEA: If a participant has had three or more watery stools in a 24-hour period, they should be kept home and return only after being symptom-free for 24 hours. 4. COLDS: It is important for a participant to stay home at the beginning of a cold, as it is the most infectious time and when she/he feels the worst. Please keep the participant at home if they are experiencing discomfort that would interfere with their ability to participate activities (e.g. coughing, severe lack of energy). If the participant experiences green or yellow nasal discharge that continues throughout the day, a cough that lasts longer than 10 days, or is accompanied by a fever or chills and is productive of discolored sputum, please consult with your physician. The participant should only return to All Aboard when they no longer have symptoms and feel well. 5. COUGH OR CONGESTION: The participant should remain home if the cough or congestion interferes with breathing and/or if wheezing. 6. CONJUNCTIVITIS (PINK EYE): Following a diagnosis of bacterial conjunctivitis, the participant may only return to All Aboard 24 hours after antibiotic treatment has begun. Participants with viral infection may return when eyes are clear. 7. COXSACKIEVIRUS (HAND, FOOT, AND MOUTH DISEASE): A participant must stay home during the acute stage of illness during fever or while lesions are present. 8. HEAD LICE: A participant may return to All Aboard only after treatment and when hair is free of nits. The participant's head will be checked by staff. The participant will be sent home if they arrive at All Aboard before the required 24-hour healing period. The participant must be picked up within ONE HOUR. If they are not picked up within one hour, All Aboard will charge $75 per hour for isolation care.
Hazardous Waste Charge

If a participant creates hazardous waste (i.e. vomiting, diarrhea, urine, etc.) and an All Aboard staff member is required to clean it up, a $25 charge per clean up will be applied to the participant's account.
Initial here to indicate that you have read and understood the above
Disruptive Behavior

Some of our participants may have issues with behaviors that disrupt activities and other participants. Staff will do their best to assist the participant in distress by using calming strategies. Intentional disruptive behavior will be addressed by staff adhering to All Aboard's Discipline Policy. If needed, a participant may be ushered away from other participants in order to maintain safety if a participant becomes increasingly irritated, loud, or nonresponsive to staff direction. Caregivers may be called if there is an ongoing issue, and the participant may be removed from All Aboard if necessary and/or may receive suspension if behavior continues. If the participant's caregiver is called, the participant must be picked up within ONE HOUR. If the participant has not been picked up within one hour, All Aboard will charge a fee of $75 per hour. We reserve the right to refuse service to participants that cause disruption to our activities.
Initial here to indicate that you have read and understood the above

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All Aboard Participant Application

All Aboard Newsletter

BILLING

Caregiver / Emergency Contact #1

Emergency Contact #2

Emergency Contact #3

Participant Health Information

Who is All Aboard of America 1 ("All Aboard")?

AUTHORIZATION OF SERVICES

1. Participants will only be charged for sessions attended. If a participant is present for at least 60 minutes of a session, they will be charged for the entire session.

2. We offer a morning session from 9am-noon. Drop-off for morning sessions is between 8:30am and 9am and pick-up for morning sessions is between noon and 12:30pm.

3. We offer an afternoon session from 12:00-3:00pm. Drop-off for afternoon sessions is between 11:30 and 12pm, and pick-up for afternoon sessions is between 3:00pm-3:30pm.

4. Drop off (before 11:30 AM) and Pickup (after 12:30 PM and after 3:30 PM for afternoon sessions) will be charged $25 per 15 minutes. Drop off before 11am for the afternoon session will be charged for a full day session.

5. The cost per 3-hour session is $55.00. There are financial resources available on All Aboard’s website if needed.

6. Attendance will be taken by computer and paper for each session.

7. A participant will not be released to someone who is not their parent/guardian, or is not listed above ("Who has permission to pick up the Participant?" in Section 1 of this form), unless it is DART or PARA transit and the participant's name is on the official roster.

8. If there is a change in attendance, it is the care provider's responsibility to contact DART or PARA to cancel the participant's ride.

10. Unpaid balances on accounts (30 days after date of invoice) will incur a $35 late fee on the invoice. We reserve the right to refuse service to participants that have unpaid bills over 30 days.

Food Allergies

Snacks and Lunches

Suspension

Items Lost

Participant Requirements

Emergency and Safety

Participant Illness

Hazardous Waste Charge

Disruptive Behavior

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