Abilities Centre Profile

This form provides information to all departments at the Abilities Centre. Each individual only needs to fill out this profile one time per year, if there are any updates to any of the information it is the individual's responsibility to submit another profile to reflect the updates.

Please note filling out this Abilities Centre profile does not automatically mean you are registered and accepted into the program you indicate interest in. Once you submit your profile, an Abilities Centre staff member will follow up with you regarding an intake specific to the programs you have indicated you are interested in attending.

Individual Information

Please enter using format MM/DD/YYYY or use calendar

Are you registered with Developmental Services Ontario (DSO)?*
Are you an Abilities Centre member?*

Goal Collection

Consider any goals you have for movement/physical activity, social connectedness, community engagement, or pre-employment skills.

Programs & Services

Please read the description of the programs listed below and select if you are interested in participating.


For the programs you are interested in, please answer the questions that pop up specific to each program.


Programs with a Dollar sign ($) beside their name are fee-based programs.

Therapeutic Recreation - Active Connection ($)*

Active Connection is a great introductory program to Abilities Centre and promotes physical activity, social interaction, and skill building via a 2-hour evening program. The first hour focuses on getting participants active through fun and engaging court-based movement activities, supporting the development of physical literacy skills and a healthy, active lifestyle. The second hour focuses on goal setting and achievement to build confidence and motivation. The whole program embeds opportunity for socialization, social skills and relationship-building through recreation activities


Are you interested in the Active Connection program?

Therapeutic Recreation - Creative Café ($)*

Creative Café is a great outlet at Abilities Centre to promote self-expression through a variety of creative activities. By utilizing painting, drawing photography, singing, and other forms of expressive art, the program provides the opportunity for participants to identify emotion, explore values, and identify one’s own goals and strengths


Are you interested in the Creative Café program?

You.Me.We (Virtual program)*

You.Me.We. (YMW) is a free, online program for teens aged 14-19. YMW will provide opportunities for teens to be active and social in an inclusive, supportive environment. Join us Tuesday evenings from 7:15-8:15pm for weekly themes, games, and fun activities! This is a great option for teens of all abilities and backgrounds, especially as an option to joining larger, in-person sessions. Stay with us for a couple sessions or all 12 weeks. We can’t wait to meet you!


Are you interested in the You.Me.We. virtual program?

Unlocking Leaders*

Unlocking Leaders is a free 10-week evening program for youths aged 15-29 that focuses on enhancing 21st century skills to build youths confidence to become a leader in their own lives. Unlocking Leaders focuses three pillars:


  • Learning skills - skills needed to succeed such as critical thinking, collaboration, communication.
  • Life skills - skills needed to get through day to day challenges like adaptability, initiative, grit.
  • Literacy skills - skills needed to access information and use technology.


Are you interested in the Unlocking Leaders program?

Pathways (Day Session) ($)*

Pathways is a 12-week program for individuals over the age of 14 with disabilities that focuses on developing skills to foster independence and community engagement. Individuals will build functional skills with the goal to enhance community navigation, money education, and decision-making skills in their community through various experiential learning opportunities with local community connections. Pathways uses an evidence-based approach to inform program delivery.


Are you interested in the Pathways (Day Session) program?

Pathways (Evening Session) ($)*

Pathways evening is an 11-week program designed to introduce youth with disabilities over the age of 14 to community engagement by building skills and awareness related to transit, going out, recreation and dining out. Pathways evening uses an evidence-based approach to inform program delivery.


Are you interested in the Pathways (Evening Session) program?

EmployAbilities Workshop*

EmployAbilities supports individuals to develop the soft skills related to employment that are needed to identify employment, educational and/or volunteer opportunities that match their skills, goals, values and strengths. In the 5-week workshop, individuals will learn self-discipline, teamwork and self- advocacy skills in relation to employment. Participants will use this knowledge and work with their Employment Specialist to plan out their next steps.


Are you interested in the EmployAbilities workshop?

Connect2Work Workshop*

Connect2Work is a four (4) week employment workshop that supports individuals to acquire the skills needed to prepare for, obtain, and maintain employment. Individuals will learn about networking, interviewing, building their resume, and applying for jobs. Participants will use this knowledge and work with their Employment Specialist and Job Developer to plan out their next steps.


Are you interested in the Connect2Work Workshop?

Therapeutic Recreation - Stronger Together ($)*

Stronger Together is a program for youth ages 14-18 that uses recreation, sport, and physical activity to build the skills necessary to join community activities and programs, be successful in a school environment, and increase overall quality of life. Throughout the program, the TR team will communicate with individual's educators and supports from school, as well as engage with clinicians, OTs, and/or therapeutic professionals to best support individual's development.


Are you interested in the Stronger Together program?

Medical Information

Do you have any allergies?*
Do you require an epi-pen?*
Do you have diabetes?*
Do you experience seizures?*
In case of emergency, do you take any medications that you would like shared with emergency services?*

Please note, Abilities Centre staff do not administer medication

An Abilities Centre staff will follow up to confirm any medical information needed to support you while you are in the centre.

Social, Emotional, and Physical Information

Do you experience any of the following communication considerations?

E.g., shyness, anxiety, seeking attention, etc.

If yes, please describe

E.g., access needs, fine/gross motor needs, extra time, triggers or words to avoid, routines, etc.

Guardian/Caregiver Information

Which email should staff use for communication?*

This should be the number where this individual is best reached during any Abilities Centre program hours

Emergency Contact Status*

MUST be available during programming hours in case of emergency.

Additional Support Information

To ensure that all individuals can meaningfully participate in the programs and services offered at Abilities Centre, additional support may be required. Abilities Centre staff may reach out to individual/caregiver to request additional support at anytime during program if individuals needs exceed capacity of AC staff.


Considerations that require additional support at Abilities Centre programs include:

  • Medical support needs (I.e., G-tube, trachea tubes, requires suctioning, etc.)
  • Behavioural support (I.e., Physically or verbally aggressive, emotional, etc. )
  • Support needed to feed, transfer, or perform personal hygiene
  • Medication administration during program times


External Supports will assume the following responsibilities when attending programs and services at Abilities Centre to assist with the performance of tasks or completion of activities that are beyond the scope the duties of Abilities Centre staff. This includes:


  • Assume full responsibility for the individual’s medical, physical and/or behavioural needs and safety while engaged in any AC program or service.
  • Performing personal care needs such as: feeding, toileting, transferring, administering medication, etc.
  • Support or assistance related to the following: aggressive behaviours, inability to follow directions, behaviours that may put themselves or others at risk.
  • Provide guidance, clarification, instruction, and direction as needed to ensure and maintain the safety of the individual and as it pertains and relates to other members.
  • Promote independence and assist individual while not completing tasks for them but instead providing encouragement and guidance where seen fit.


If the external support does not follow or meet the above expectations AC staff will follow up with individual’s family to discuss possible solutions.

Will you be attending programming with an external support?*

I.e., companion, support person, or caregiver

If yes, please fill out the below information

Travel

All programs at Abilities Centre are for individuals of all abilities. To respect everyone's independence ensure their safety, please check all boxes that apply:
Are there any specific pick-up or drop-off instructions Abilities Centre staff should be aware of?*
Can you independently leave Abilities Centre if your program has a scheduled break or lunch?*
Can you independently wait for your travel home at the end of scheduled AC programming or services?*
Can you independently leave Abilities Centre property at the end of scheduled programming?*

I.e., walking home, driving home, taking public transit

Abilities Centre Demographics questions

These demographic questions help Abilities Centre to better understand our community. This information helps us to make sure we are meeting our community's needs. Our goal is to be more open and responsible in Inclusion, Diversity, Equity, and Accessibility (IDEA).


Each question has a "prefer to describe" option. This will give you a text box, and you can use the words that best describe you. Each question also has a "prefer not to answer" option. All demographic questions are voluntary. Some questions also have a "not applicable" option. If the question does not apply to you, please feel free to select that option.


The information is gathered with your profile, but the demographic information will not be looked at for each individual. Demographic information will be pooled with responses from all members or Abilities Centre's community. When looking at and reporting demographic information, Abilities Centre will not include any personally identifying information. Individual's confidentiality will be protected. If you have any concerns about how your data is being stored or managed, please contact our research department at research@abilitiescentre.org

For example: She/Her, He/Him, They/Them

(2S: Two-Spirit, L: Lesbian, G: Gay, B: Bisexual, T: Transgender, Q: Queer or Questioning, +: acceptance and embracing of all genders)

Ethno-cultural identity is a broad concept. It looks at how people belong to different groups. These groups share similar characteristics. Some examples are a shared language, religion, traditions, nationality, and more.


Use the check boxes below to select your ethno-cultural identity or select prefer to describe and use the open text box. Select as many as apply. The examples provided are there as a guide. However, there are many more than included on this list.

Race is different from ethno-cultural identity. Race depends on how others view the way you look. There is no true difference between people who are perceived to be in different racial groups. But race has been used to give some people power and others not and still impacts people’s inclusion in society.


Use the open text box to describe your race. Or use the check boxes below to select your race. Select as many as apply.

It is important to Abilities Centre that money is not a barrier for our community. To help ensure accessibility and inclusion in our programming, we would like to know the household income of our community members. Household income is the approximate amount of money earned by all members of the household who contribute to expenses.

Consent

Abilities Centre is committed to protecting the privacy of its members. Abilities Centre staff treat the personal information of individuals participating in the Abilities Centre programs as confidential and share such information only as required by law or for consistent purposes as outlined in the Freedom of Information and Protection of Privacy Act. Individuals have a right to know how their information has been used and to whom their information has been disclosed. Personal information about individuals participating in the Abilities Centre programs are used for the sole purpose of facilitating the programs. It is treated as confidential, securely stored, and is accessible to and shared amongst Abilities Centre staff only on a need to know basis.


By clicking the box, I acknowledge and agree to the statements made above

Please note that while we are happy to provide at home resources for continued physical activity at home, you are performing these activities at your own risk. For any programming specific to physical activity, please do not participate in these activities if you are injured, sick, dizzy, short of breath or are experiencing any other health related issues. The contents of this video are intended for Abilities Centre registered participants and should not be used by anyone not registered within the program. Abilities Centre will not be responsible or liable for any injury or harm you sustain as a result of our programming. Prior to starting exercise, it is your responsibility to ensure your activity area is free from obstacles or debris to ensure your safety during the activity. Participants 12 years of age or younger should obtain permission from, and be supervised by a guardian/caregiver prior to and during participation.


By clicking the box, I acknowledge and agree to the statements made above.

By checking the box, I hereby grant and release to Abilities Centre the right to use photographs, audio tapes and/or videotapes in which I appear in any information, promotional and/or marketing materials such as videos, films, recordings, still photographs, digital images, social media (Facebook, Twitter, You Tube, Instagram, etc.) or articles relating to Abilities Centre, its programs and services including but not limited to, membership brochures, newsletters, annual reports or our website, whether broadcast on television, radio or any other medium. In the event that these images are to be used for any other purpose by Abilities Centre that is inconsistent with the purposes outlined above, it is understood and agreed that my prior consent shall be obtained.

Program evaluation consent

Consent to collection of de-identified attendance information*

As part of the program evaluation process, we will be tracking your attendance in the program. All information collected will be de-identified, meaning your name will be removed. The information will be stored on a password-protected computer. Only necessary Abilities Centre staff involved in the program will be able to access the information. This information will only be shared in summary form in reports. Collection of this information is necessary to run programming; however, we are happy to discuss this process further with you if you have questions. Please check one of the boxes below to indicate your response.

Consent to collection and sharing of de-identified program evaluation information*

Part of the evaluation process also involves collecting information from individuals about their experience in programs/workshops. This may involve surveying you about your experience in the program, interviewing you about your experiences in the program, observing individuals participating in the program (e.g., to assess the level of engagement, development of relevant skills, etc.) and/or any other activities that might provide you with an opportunity to communicate your experiences in the program. Participation in these evaluation activities is voluntary and you can withdraw your consent to participate in the evaluation at any time by emailing research@abilitiescentre.org or telling any Abilities Centre staff involved in the program you are participating in. Your involvement in the program will not be affected; you will be free to participate but your information will not be recorded.

If you choose to participate in the evaluation, your information will be protected. All information collected will be de-identified, meaning your name will be removed and an anonymous code will be used. Individual responses will not be made public, but the aggregated data will be included in reports and used in quality improvement research. The information will be stored on a password-protected computer. Only necessary Abilities Centre staff involved in the initiative will be able to access the information.

Consent to be invited to share experiences in Abilities Centre programming*

Throughout your time in Abilities Centre programs, there may be some opportunities to share experiences by doing interviews or sharing testimonials. For these opportunities, we may ask to share your personal reflections on your experiences in the programs and possibly your name. Providing this information will identify you to the public. This information is sometimes shared by Abilities Centre on social media, on our website, or in reports. The goal is to share what is happening with Abilities Centre programs with other people. Abilities Centre will only share your name or your words with your permission. Before sharing your information, an Abilities Centre staff will reach out to you to verify your consent to have this information shared.


If you would like to share your experiences in Abilities Centre programming and select "yes' below, please provide an email address or phone number below where an Abilities Centre staff can contact you for permission to share your testimonials.


You can take back consent at any time by emailing research@abilitiescentre.org or telling any Abilities Centre staff involved in the program you are participating in.

Future Communication

By checking the box, I consent to be contacted about research opportunities with Abilities Centre and/or their partners. I acknowledge that my email will be shared with the research department of Abilities Centre for research purposes only. If at any point you no longer want to received emails about research opportunities, please email research@abilitiescentre.org to be removed from this list.

I consent to receive offers and other promotional and marketing materials by email from Abilities Centre. I understand that I can later withdraw consent by using the unsubscribe option in emails or contacting the sender.

Please enter your full name in place of a signature

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