Respite Programs

Lola’s Round Table’s Respite Programs & Services

Learn about the Respite programs Lola’s Round Table offers. Click the buttons below to view future programs, and apply to our Respite programs and our new Summer Youth Pilot Program.

Apply for Lola’s Summer Youth Pilot Program (High School Students Ages 15-21)Apply for Weekday Respite Apply for Saturday Respite View Future Programs

Current Programs

Weekday Respite Program

Monday – Friday: 9:30am – 3:30pm

Pick up and drop off provided at no extra cost between 8:00am – 9:30am & 3:30pm – 5:00pm
Occasional lunch program
Activity costs covered

*Wait list available when days are full

Apply for Lola's Respite Programs

Summer Youth Program (Starts Summer 2023)

July & August (Monday, Wednesday, Friday): 9:30am – 3:30pm

No pick up or drop off offered
Occasional lunch program
Activity cost not included (temporary)

*Must have a minimum of 3 people to run the program

Apply for Lola’s Summer Youth Pilot Program (High School Students Ages 15-21)

Lola’s Summer Youth Pilot Program (High School Students Ages 15-21)

*Please note: this program has limited spots. Filling out an application does not guarantee a spot in the summer youth program. Once applications are submitted you will be contacted for an in person meeting. We will review and you will be contacted if your application has been accepted for the program.

Lola’s Summer Youth Pilot Program Application

Applicant Name(Required)

First Last

Guardian Name(Required)

First Last

Age(Required)

Please enter a number from 1 to 110.

Birthday(Required)

MM slash DD slash YYYY

Email(Required)

Phone(Required)

Address(Required)

Street Address City Province Postal Code

Preferred Method of Contact(Required)

Text

Call

Current School(Required)

*Can potentially be paired with others who attend the same school

Primary Diagnosis(Required)

All Other Diagnosis

Will you family member require medication administration?(Required)

Yes

List Medications(Required)

Does your family member experience seizures?(Required)

Yes

List Types(Required)

Does your family member have allergies?(Required)

Yes

List Allergies(Required)

Additional Medical Information

Mobility(Required)

Good

Unsteady

Depth perception

Requires assistance

Visibility(Required)

Good

Poor

Has glasses

Auditory(Required)

Good

Poor

Hearing impaired

Selective listening

Requires people to repeat

Are there environmental factors to consider for your family member?(Required)

Yes

Please explain what environmental factors could trigger anger, fear, excitement and overstimulation?(Required)

Behavioural

Please list any behaviour challenges below that we should be aware of (ex. hitting, biting, throwing objects, self-injurious, flight risk).

Dietary

Please list any dietary challenges we should be aware of (ex. foods to avoid, food consistency: cut up, minced, puréed).

Safety

Please list any safety related challenges we should be aware of (ex. safety awareness, stranger danger, crossing the street, etc.).

Communication-Receptive(Required)

How does your family member understand communication?

Communication-Expressive(Required)

How does your family member communicate?

Personal Care(Required)

Please list anything we should know about your family member's personal care (ex. they are independent, they need some assistance with bowel movements, they require complete assistance, they wear a guard/brief, etc.).

Personal Finance(Required)

Please list anything we should know about your family member's personal finance (ex. they understand how to handle money, they have little to no understanding, they can hold their own wallet, etc.).

Special Protocols

Please list any special protocols below (ex. missing person, behavioural, emotional, boundaries, etc.).

Likes(Required)

Please list what your family member likes.

Dislikes(Required)

Please list what your family member dislikes.

Fears(Required)

Please list any fears your family member has.

3 + 9 =(Required)

(After entering the correct answer in the box above, the Submit button will appear.)

Name

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

Apply for Lola’s Weekday Respite Programs

Fill out the form below to apply to Lola’s Weekday Respite Program.

Note: Lola’s Roundtable currently does not have the capacity to support individuals with complex and challenging behaviours that may put themselves, our members and our staff at imminent risk of harm.

Lola’s Roundtable also has limited ability to support individuals who require wheelchairs, lifts and slings. Lola’s is working diligently on our growth to accommodate these needs.

You will be contacted immediately after your waitlist submission via email with more information about our program.
You will be invited to come tour Lola’s location (optional)
Waitlist will be in the order of application submission dates
You will be contacted if there is an open spot for your family member by June 2025
You will be contacted if the waitlist will surpass June 2025

I understand there is a waitlist until June 2025(Required)

Yes

I would like a tour of Lolas program while my family member is on the waitlist (a tour can help families and new applicants determine if our program will be the right fit)(Required)

Yes

I will continue to look for another program(Required)

*Note: if you join another program, you must disclose to the program that you are on our waitlist and may potentially switch programs

Yes

I would like another tour once my family member is taken off the waitlist(Required)

Yes

Questions and Comments Regarding the Waitlist

Applicant Information

Name of Applicant(Required)

First Last

Age of Applicant(Required)

Applicant's Birthday(Required)

Name of Parent / Guardian(Required)

First Last

Email(Required)

Phone(Required)

Preferred method of contact(Required)

Call

Text

Address(Required)

Street Address City Province Postal Code

Primary Diagnosis(Required)

All other diagnosis (if applicable)

Will applicant require medication administration while at Lola's?(Required)

Yes

Yes, please administer medication while at Lola's.(Required)

Please list the name of medication(s), dose(s) required, route(s) and time(s).

Does the applicant have seizure activity?(Required)

Yes

Yes, the applicant has seizure activity.(Required)

Please explain the type of seizure and protocol needed.

Allergies

Please list any non-threatening allergies and/or life threatening allergies, along with any protocols needed (if applicable).

Requirements / Considerations

Mobility(Required)

Does the applicant require assistance with mobility while at Lola's?

Yes

Visual(Required)

Are any visual accommodations needed at Lola's?

Yes

Please explain mobility assistance required.(Required)

Please explain visual accommodations.(Required)

Auditory(Required)

Are any auditory accommodations needed at Lola's?

Yes

Environmental(Required)

Are any environmental accommodations needed at Lola's?

Yes

Please explain auditory accommodations.(Required)

Please explain environmental accommodations.(Required)

Personal Care(Required)

Will the applicant require any kind of personal care while at Lola's?

Yes

Safety(Required)

Does the applicant understand safety awareness?

Yes

Please explain what type of personal care is needed.(Required)

Please explain.(Required)

Communication-receptive(Required)

Does the applicant understand what is being said to them?

Yes

Communicative-expressive(Required)

How does the application communicate with others? Please explain below:

Dietary(Required)

Does the applicant have any dietary restrictions?

Yes

Please explain what dietary considerations/restrictions the applicant has:(Required)

Behavioural(Required)

How does the application express themselves behaviourally towards others and themselves? Please explain below:

Immunizations up to date (including COVID-19 vaccine)?(Required)

Is the applicant's immunizations (including the COVID-19 vaccine) up to date?

Yes

No, the applicant's immunizations are not up to date.(Required)

Please list immunizations applicant has had below:

8 + 3 =(Required)

(After entering the correct answer in the box above, the Submit button will appear.)

Phone

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

Apply for Lola’s Saturday Respite Program

Fill out the form below to apply to Lola’s Saturday Respite Program.

Name of Applicant(Required)

First Last

Age of Applicant(Required)

Applicant birthday(Required)

Name of Parent / Guardian(Required)

First Last

Email(Required)

Phone(Required)

Preferred method of contact(Required)

Call

Text

Address(Required)

Street Address City Province Postal Code

Primary Diagnosis(Required)

All other diagnosis (if applicable)

Will applicant require medication administration while at Lola's?(Required)

Yes

Yes, please administer medication while at Lola's.(Required)

Please list the name of medication(s), dose(s) required, route(s) and time(s).

Does the applicant have seizure activity?(Required)

Yes

Yes, the applicant has seizure activity.(Required)

Please explain the type of seizure and protocol needed.

Allergies

Please list any non-threatening allergies and/or life threatening allergies, along with any protocols needed (if applicable).

Requirements / Considerations

Mobility(Required)

Does the applicant require assistance with mobility while at Lola's?

Yes

Visual(Required)

Are any visual accommodations needed at Lola's?

Yes

Please explain mobility assistance required.(Required)

Please explain visual accommodations.(Required)

Auditory(Required)

Are any auditory accommodations needed at Lola's?

Yes

Environmental(Required)

Are any environmental accommodations needed at Lola's?

Yes

Please explain auditory accommodations.(Required)

Please explain environmental accommodations.(Required)

Personal Care(Required)

Will the applicant require any kind of personal care while at Lola's?

Yes

Safety(Required)

Does the applicant understand safety awareness?

Yes

Please explain what type of personal care is needed.(Required)

Please explain.(Required)

Communication-receptive(Required)

Does the applicant understand what is being said to them?

Yes

Communicative-expressive(Required)

How does the application communicate with others? Please explain below:

Dietary(Required)

Does the applicant have any dietary restrictions?

Yes

Please explain what dietary considerations/restrictions the applicant has:(Required)

Behavioural(Required)

How does the application express themselves behaviourally towards others and themselves? Please explain below:

Immunizations up to date (including COVID-19 vaccine)?(Required)

Is the applicant's immunizations (including the COVID-19 vaccine) up to date?

Yes

No, the applicant's immunizations are not up to date.(Required)

Please list immunizations applicant has had below:

8 + 8 =(Required)

(After entering the correct answer in the box above, the Submit button will appear.)

Name

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

Future Programs

Saturday Respite Program (Starts November 4, 2023)

Saturday: 10:00am – 3:00pm

Cost: $100/day

Groups: 4 Members per group

Pack a lunch unless specified otherwise
Lola’s will aim to cover all activity costs
Pick up and drop off service is to be determined

Saturday Respite Form

Weekend Overnight Respite

(not available yet)

Friday – Sunday

All meals included
No pick up or drop off

Lola’s Round Table’s Respite Programs & Services

Current Programs

Weekday Respite Program

Summer Youth Program (Starts Summer 2023)

Lola’s Summer Youth Pilot Program (High School Students Ages 15-21)

Lola’s Summer Youth Pilot Program Application

Apply for Lola’s Weekday Respite Programs

Applicant Information

Requirements / Considerations

Apply for Lola’s Saturday Respite Program

Requirements / Considerations

Future Programs

Saturday Respite Program (Starts November 4, 2023)

Weekend Overnight Respite

Contact Us

Payment Methods

Additional Info

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