E-mail: nextstepfarms19@gmail.com Web site: https://nextstepfarm.godaddysites.com

 Mission ~ Our mission is to provide a safe and nurturing day program for individuals with intellectual and developmental disabilities who seek to participate in a homestead type environment.

 Vision~ The Vision of Next Step Farms is to provide a hands on program for special needs adults through the production of farm fresh protein, produce, and products generated through the homestead environment.

 Why~ Answering a need
In the American Education system, students with special needs are permitted to remain in a public learning institution until age 21. Once the age is reached, it is hoped that necessary skills to independently thrive as much as possible in the Community, in the Workplace and in their daily life have been acquired somewhere along the line. The Federal Addition of Mandatory Transition Skills (implemented beginning at age 15)helped to fill the gap for some but did not provide enough training for the individual to be independent. For students with a below average to average IQ (75 and up) and with mild disabilities, independence is often times achieved via a trade school, a community college or a university. For students with low cognitive ability (40 or lower) ,limited mobility and lack of independence, facilities and Medicare often provide care giving service either on a day service provision or through a residential facility. But what about the students who fall in between? Their cognitive ability placed them lower than those who could manage the pace and rigors of a trade school and the independence of being on their own yet they do not require full time supervision. Their independence was just enough yet not enough. They have become the forgotten. They are the sociable individuals who need more assistance learning a skill. Currently these individuals sit at home with nothing to do, they sit at their parents places of employment appearing busy or completing rudimentary tasks to keep them occupied. These tasks are not necessarily beneficial to the company, but busy work for the individual. According to the 2017 Disabilities Statistics Annual Report, approximately 4.8% (21,000) of the population in Huntsville, Alabama have a cognitive disability and could fall into this category. They have a few options but what if we could give them more? What if we could provide them with a functional hands on learning environment? What if these young adults could learn a real skill that would provide the community with healthy choices and the young adults with meaningful employment? We have a need. A need for the Next Step in life.

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 Culture Statement~
At Next Step Farms, our goal is to create a day care program with a homestead feel for individuals ages 18 and up who have special needs. Areas of daily routine involvement and opportunity at Next Step Farms include but are not limited to:
o	Animal Husbandry
o	Horticulture/Landscaping
o	Mechanical Maintenance
o	Culinary Techniques
o	Data Entry
o	Basic Finance
o	Daily Living Skills/Healthy Living
o	Crafts

Requirements
Candidates will complete an application that will be reviewed by designated personnel. To qualify for consideration, applicants must meet the following criteria:
●	Display a cognitive or developmental IQ below 65
●	Age 18 or older
●	Independently mobile
●	Able to convey personal and/or medicinal needs independently
●	Able to complete tasks in a supervised environment
●	Able to accept each other understanding that we have our own abilities and limitations.
●	Able to encourage one another in positive ways.
●	Able to fully participate in teaching, learning, work and social activities.
●	Aim to work as a team until the task at hand has been completed.
●	Create a culture free of abuse, harassment and unfair criticism.
Applicants and their support networks would meet with personnel to ease the transition and determine a start date. Once accepted, attendees can choose the program that best suits their personal goals and abilities.
These fees will help meet the obligations of day to day operations.
Daily Program	Select Day Program	
●	Attends 5 days a week
●	Fee $85 a day	●	Attends 2 to 4 scheduled days per week
●	Fee $100 per day	

 Transportation~ Families must arrange for all participants’ transportation.
 Location of Services~ Services are provided only at TBD.
 Hours of Services~8:00- 4:00 Monday through Friday. If extended hours become available (extra fees of $10 per half hour will apply). Participants may choose to attend five days a week or for a minimum of two prearranged days.
Holiday closings will be denoted on the yearly calendar
Inclement weather policy: Next Step Farms will be closed when Madison County schools are closed due to weather conditions,
 Health-related Medical Support Services~ This facility does not provide any type of medical treatment. We are happy to provide personal medication reminders as needed. Participants should be able to operate, maintain and administer life saving devices /medications. Caregiver may schedule any specialist onsite visit to benefit good health of the participant. A first aid/sick room is available to isolate a participant who becomes ill during their scheduled time at the Farm until responsible guardian arrives. EMS will be called if necessary for any emergencies.

Criteria and Agreement Contract for participants of Next Step Farms
●	Participants must display a cognitive or developmental IQ below 65
●	Participants must  be age 18 or older
●	Participants must be independently mobile …use of assistive devices is considered mobile
●	Participants must be able to understand and follow simple directions and sit for group activities.
●	Participants must not present a significant threat to themselves or others.
●	Participant should be able to communicate needs and thoughts for sufficient benefit.
●	Participants must be either continent of bowel and bladder or be able to independently attend to bathroom needs independently of staff supervision. Reminders will be given if needed.
●	Participants who require medication during the day must bring medication in a duplicate prescription bottle with dosages and schedule indicated. If a medication is required at multiple times daily while in attendance each dosage must be in a separate duplicate prescription bottle with dosage and schedule indicated. The bottle should contain only the exact dosage needed for the specific time for that day. Staff does not administer medication. Participants will be solely responsible for self- administering medication.
●	Participants must not require nursing care or attend with a fever or serious illness.
●	Family members /responsible guardian must provide or arrange all transportation for participants.
●	Participants may be suspended or terminated from the program for the following: behavior which is severe and cannot be managed at the Farm (within the sole discretion of Next Step Farms); any communicable diseases that presents a direct threat to the participants, employees, or volunteers; when participant no longer meets criteria; failure of responsible party or caregiver to adhere to center policies; and failure to pays fees prior to service.
●	Participants and Staff with infectious disease or illness such as vomiting, or diarrhea are not allowed to attend center. This is a non-medical facility therefore any participant who becomes ill or injured at the center must be picked up by caregiver or designated driver, within one hour of notification by staff.
●	Center  closing  dates  will  be  published  in  newsletter.	Center  may  close  for  inclement weather conditions. If Madison Schools are closed for inclement weather this adult day center will be closed.
●	A late fee will be charged for any fees, which are not paid in 30 days.
●	If participant becomes anxious and ask to leave before scheduled pickup caregiver will be called.
●	No refunds will be made for any absences without prior notice of at least [72] hours.

Participant Signature 			Date  	____________

Caregiver / Guardian Signature 			Date  	____________ 

Relationship to Participant: 						

Witness	 		Date  	

A copy of this form will be made for your records

 Client Information

Next Step Farms Participant Information

Name 	D O B 	/	/	
Address  	
Age 	Sex 	Race 	Ethnicity  	
Primary Caregiver 		Phone 		Email			 Power of Attorney      Y or N	Name 		Ph # 		(provide copy) 
Guardianship Order   Y or N	Name 		Ph # 		(provide copy) Emergency Contact #1  						

Phones: Home  	

Work  	

Cell  	

Emergency Contact #2  	

Phones: Home  	

Work  	

Cell  	

Please describe any special needs (ex: autism spectrum, Down syndrome, mental or physical disability): 

Who is authorized to transport the participant? If needed, use the back of this page to list all who may transport participant.
Name  	
Phone #: Home 		Work#:   	
Any repetitive behaviors?  	
Any additional information that may be helpful to us?   ________________________________________	

 Medical Information
Personal Physician 		Phone #  	
List of prescription and non-prescription drugs the participant currently takes:   	

Complete form titled: Current Prescription Medication Form.
List known allergies of the participant:   	

Is participant on a special diet?	If yes explain  	

Special Instructions for Emergency Care:   	
Notice: Our office must be notified in writing of any changes in the information provided concerning the care of the participant listed above to assure information and records are current and accurate in case Emergency Medical Services (EMS) is needed.

 Activities of Daily Living
Please help us to know the participant better….
Communication Needs	Yes   or  No
Explain if yes  	
Ability to use telephone? 	Comments  	

Vision/Hearing Needs	Yes  or  No Hearing aid Yes   or  No
Vision problems, glasses, or other?   	
Toileting Needs	Yes   or  No
Explain if yes  	

Instructional Needs	Yes   or  No
Explain if yes  	

Follows simple instruction? 		Comments  	
Other special needs or concerns?  	

Does participant wander or try to leave premises?	If yes, explain.   	

Medication Needs while at the Farm	Yes   or  No
If yes, specify 	
Can participant self-administer required medication? Yes or No 

Publication Release Form

Participant Name:  	 (“Participant”)
I give permission for the day center staff or designated volunteer to (check all that you agree to):
□	Take a photograph or video tape of Participant
□	Record Participant’s voice
□	Use Participant’s art work or a reproduction thereof
□	Arrange for publication of Participant’s photo for local newspaper(s) and/ or social media (Facebook, website)
Furthermore, I authorize the use and reproduction of these for publicity or education and informational purposes without compensation to Participant or me. All copies and negatives shall constitute the property of Next Step Farms. I understand that only first names will be used for identification purposes. I understand that I will be given advance notice of any photo sessions which will be published in a newspaper. I
can refuse individual photo sessions at any time. 

Caregiver Initials	Date  	

Please Note: Failure to agree to any of the items on this release form will not affect Participant’s eligibility for the program.

 Contract for Attendance
The agreement with Next Step Farms has been explained to me and I have been given a copy of the policy statement. I am enrolling:  	  (“Participant”)
For: Monday	Tuesday	Wednesday	Thursday	Friday (circle days that apply)
On behalf of Participant, I agree to pay monthly for care at the rate of $ 	per day and I understand that this amount is due prior to the service.
Next Step Farms staff agrees to accept this participant for enrollment under the following conditions. Full time(M-F) 	Effective date 	Signature  	
Part time: 	days a week  Effective date 	Signature  	
Monday	Tuesday	Wednesday	Thursday	Friday
If emergency medical care becomes necessary, I give permission for any treatment the staff deems necessary. I understand any charges incurred for medical care will be the sole responsibility of the Participant and/or myself.

I, 	, have read and understand the current Policies and Admissions Agreement, the rules and criteria of the adult center and agree to abide by them.

Date  	

Signature  	
(Parent/Guardian)
(“Caregiver”)

Date  	

Signature  	
(”Participant”)

Date 		Witness  	

 Waiver of Liability

Participant’s Name  	
I hereby give permission for Participant to participate in the adult center activities describe below.
Neither I nor the Participant will hold any of the Next Step Farms staff, volunteers, or board members responsible for any injury to the above-named participant which occurs during any of the activities listed below. The Participant and I agree to hold Next Step Farms, including any employee, board member, officer, or volunteer, harmless for any and all claims that may arise out of or relate in any way to Participant’s attendance at or participation in any activity, program, class, or other service provided by Next Step Farms.

❑	Daily activities at Next Step Farms. To include but not limited to: baking or cooking activities, gardening activities, animal care, business skills, sales, personal daily living and hygiene
❑	Monitor prescription medications, as prescribed by physician. Staff will give reminders when medication is
to be taken.
□ Monitor nonprescription medications as requested by the caregiver. Caregiver is responsible for bringing the medication to  Next Step Farms in its original container.
□	Utilize exercise equipment or daily required tasks activities that are provided
□Without restrictions	□ With restrictions as listed below.

If there is an item or items, you Do Not Approve please indicate below the activity or activities to omit.

Participant Signature 			Date  	____________

Caregiver / Guardian Signature 			Date  	____________ 

Relationship to Participant: 						

Witness 		Date  	

Medication Assistance Form
I request staff of Next Step Farms assist and monitor medications for 	as ordered by Dr. 	.  I have read the policies concerning medications and will inform the staff of any changes made in the medication.

Caregiver 		Date  	

Witness 		Date  	

 Current Prescription Medication Form

Date: 		Review Date:   	
Participant’s Name:  	
Allergies:  	
Note: Please, fill out this form or have your pharmacist fill it out. The caregiver is responsible for notifying our office in writing of any change in medication. Each medication must be brought daily in a
prescription bottle/container. N o medication will be stored overnight at the center.

Name of Responsible Party	Signature  	
Physician  	

Medication	Dosage	Time	Start Date	Purpose	Side Effects	

						

						
Note: This form will be updated every 6 months or as medications are changed by the participant’s physician.