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Adult Day Program

ELIGIBILITY SCREENING — Lola’s Adult and Youth Programs


Please complete this quick screening to determine whether our group-based respite program is a suitable fit.
Your answers help us ensure safety, comfort, and appropriate staffing for all participants.

This field is for validation purposes and should be left unchanged.

1. Mobility & Group Movement

How does your family member move around independently in a group setting?(Required)

2. Safety & Supervision

In the past 12 months, has your family member attempted to leave a supervised indoor or outdoor space without permission?(Required)
Does your family member require 1:1 support in community or group settings to stay safe?(Required)

3. Behavior in Group Settings

In the last 6 months, which of the following behaviours has occurred?(Required)
(Select all that apply)

4. Regulation & Support Needs

When your family member becomes upset, what level of support do they typically need?(Required)

5. Group Program Readiness

Has your family member successfully participated in group programs without needing 1:1 staffing?(Required)

Disclaimer

Completing this eligibility screening does not guarantee acceptance into Lola’s Adult and Youth programs.
All information provided must be accurate and truthful.
Lola’s reserves the right to decline or terminate services at any time if inaccurate or misleading information is discovered, or if a participant’s support needs exceed what our group-based program can safely provide.