Family Engagement Center Suite Reservation Form

1
Requester Name* This field is required.
First Name
Last Name
2
Loved One Receiving Services* This field is required.
First Name
Last Name
3
Requester Phone Number* This field is required.
Area Code
Phone Number
4
Requester Email Address* This field is required.
example@example.com
5
Springbrook Program* This field is required.
A Resident of Community Homes
Student at the School at Springbrook
6
Residential Program Location
Highland
Hilltop
LeChase
McDowell
Scriven
Snell
Sunshine
Susquehanna
Taylor
Wright
7
Community Home Location
Bird Ave
Broad St
Cook St
Earlville
Ford Ave
GlensBridge
Grandview
Hayes St
Johnston Circle
Kelly Corners
Milford
Morris
Nichols
Oak and Elm
Otego
Oxford
Pierstown
Pines
Sherburne
Stone Quarry Rd
Swart Hollow
Sweet Briar
Walnut St
West Oneonta
8
Other Guests In Party* This field is required.
First Name
Last Name
Guest 1
Row 0, Column 0
Row 0, Column 1
Guest 2
Row 1, Column 0
Row 1, Column 1
Guest 3
Row 2, Column 0
Row 2, Column 1
Guest 4
Row 3, Column 0
Row 3, Column 1
Guest 5
Row 4, Column 0
Row 4, Column 1
Guest 1
Guest 2
Guest 3
Guest 4
Guest 5
First Name
Row 0, Column 0
Last Name
Row 0, Column 1
First Name
Row 1, Column 0
Last Name
Row 1, Column 1
First Name
Row 2, Column 0
Last Name
Row 2, Column 1
First Name
Row 3, Column 0
Last Name
Row 3, Column 1
First Name
Row 4, Column 0
Last Name
Row 4, Column 1
1 of 5
9
Room Preference* This field is required.
1 King
2 Queens
Both Rooms
10
Preferred Date of Visit* This field is required.
Date
Month
Day
Year
11
Preferred Time of Visit* This field is required.
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
12
Preferred Date of Departure* This field is required.
Date
Month
Day
Year
13
Preferred Time of Departure* This field is required.
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
14
Will your loved one be sleeping at the Family Engagement Center or returning to their home?* This field is required.
Sleeping at the FEC
Returning to their house
15
Preferred Pickup TimePlease Note: The latest pick up to return to the house is 7 PM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
16
I understand/attest that:
Check in time is 3:00 PM and Check out time is 10:00 AM.
No pets are allowed at the Family Engagement Center.
No Tobacco, Alcohol, Drugs, or Weapons are allowed anywhere on Springbrook Property.
For our safety and the safety of Guests in the Family Engagement Center, I will supervise my children (including those who do not receive services) at all times.
That if I need the support of a Springbrook Staff I will discuss these needs with the house directly prior to the visit.
I am to keep my room tidy and pick up after myself and children.
Laundry facilities are available in the Family Engagement Center hallway if needed
After being used a Springbrook Staff member from facilities will clean the Family Suites.
I will take out or dispose of any ingredients or food I bring.
I will clean the kitchen after every use.
I will treat this space respectfully. It is made possible only through the kindness of our donors and we hope to continue to operate this facility for the benefit of all Springbrook families.
In the event that damages are incurred please notify a Family Engagement Center Staff or the Manager on Call immediately. Use of the space above and beyond ‘general wear and tear’ including damages to the physical space, furniture or any items will result in potential loss of Family Engagement Center privileges.
In the event of an emergency, please call 911. If a need arises after hours, please call 607-286-7171 and dial 2 for the Manager on Call, and then 1 for the Main Campus Manager on Call.

Yes No * First Name Last Name
17
There is no cost for families to use the Family Engagement Center. A suggested donation $100/night will allow us to continue this benefit, along with year-round programming in the space. Gifts on ANY AMOUNT are appreciated and can be made via credit card at www.springbrookny.org or by check payable to Spingbrook and given to a Family Engagement Center staff member or in the lock box provided in the room.
Should be Empty: