Social Recreation

The Socialization and Recreation program is ever-expanding and always open for new suggestions. With activities such as swimming, bowling, movie nights, sleepovers, sporting events and more, we strive to provide adequate socialization for Individuals with Intellectual and Developmental Disabilities.

Helping Hands provides transportation to most S/R activities, as well as meeting points in several locations for pick-up and drop-off. Incredible memories are made at each activity, and we encourage participants to suggest activities they would personally enjoy attending if they are not already on our activity menu.

For more information about this great program, please contact our Social Recreation Director, Jaimee Scott at Jscott@HelpingHandsInc.com

*2.5% convenience fee is added

Group Activities for Adults | Helping Hands Inc | Bechtelsville PA

Social Recreation Application

* All individuals interested in becoming part of our Social Recreation program must register first by 1) submitting completed application 2) submit a copy of recent physical (less than 1 year old) and 3) pay an annual fee of $25.00.

* Please allow 1-2 weeks after we receive completed application to process clients for membership approval. Thank you for your understanding.

Step 1 of 4

Name(Required)

First Last

Date(Required)

Social Security Number(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Birth Date(Required)

Age(Required)

Nationality (optional)

Parent/Guardian Name(Required)

First Last

Address/Phone (if different from above)

Place of Employment/Occupation for Parents/Guardians:

1. Employer(Required)

Occupation(Required)

Work Phone Number(Required)

Address(Required)

Street Address City State ZIP Code

2. Employer(Required)

Occupation(Required)

Work Phone Number(Required)

Address(Required)

Street Address City State ZIP Code

Emergency Contact Information:

Name(Required)

First Last

Phone(Required)

Name(Required)

First Last

Phone(Required)

Additional Information:

Case Management Office(Required)

Case Manager(Required)

First Last

Case Manager's Phone Number(Required)

Physician's Name(Required)

First Last

Phone Number(Required)

Physician's Address(Required)

Street Address City State ZIP Code

Programs of Training, both past and present:

Workshop Address(Required)

Street Address City State ZIP Code

Other/Address

Street Address City State ZIP Code

PLEASE SIGN BELOW AGREEING:
- I give my permission to Helping Hands, Inc. to provide a Social/Rec Program to the above mentioned applicant.
- I give my consent for the taking and using of above mentioned applicant for the purpose of furthering services provided by Helping Hands, Inc.
- I grant permission for the above mentioned applicant to participate in trips as part of the agency's programs.
- I grant permission for the above mentioned applicant to receive medical attention and/or treatment by a doctor/hospital and/or our staff if it is so required while he/she is attending agency programs.

Signature of Parent/Guardian(Required)

Date

Upload Completed Physical Form

Accepted file types: jpg, pdf, png, Max. file size: 2 GB.

CONFIDENTIALITY:
Helping Hands, Inc. maintains confidentiality of individual records and information in accordance with guidelines prescribed by the Pennsylvania Dept. of Welfare.
We provide services to individuals regardless of race, color, creed, national origin, handicaps, sex, or political affiliation.

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Social Recreation

Social Recreation Application

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