Pumpernickel Places
My Vacation, Inc
Autumn 2017-Summer 2018 Tours
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Travel for adults with disabilities
(800) 800-9979
Price includes:
Double room occupancy
Wheelchair lift van
1:2 and 1:1 staff to participant ratios
Personal care attendant costs
Attendantʼs airfare from key cities
All meals
245 E Old Sturbridge Rd • Brimfield, MA 01010
PUMPERNICKEL PLACES!
My Vacation, Inc
About Pumpernickel Places...
Pumpernickel Places are specialized tours
planned for vacationers needing or desiring a high
level of assistance or supervision. These tours
are wheelchair accessible and are staffed on a
1:2 and 1:1 ratio. Tours are small--typically only
three or four travelers--so daily schedules are flexible and participants receive abundant attention.
Prices include:
• double-occupancy accommodations (two people
per room)
• all meals
• all activities
• airfare for attendant (from most major cities)
• wheelchair accessible transportation
• all cruise tips (on cruise tours)
• choose from a 1:2 or 1:1 tour escort to customer ratio. You can bring your own attendant
or choose for us to provide the attendant
• pre-tour and post-tour calls from the tour leader
or tour coordinator (daily calls on non-cruise
tours, if requested)
Since our customers come from all over the country, prices do NOT include airfare for the customer
to the destination. (If you are bringing an attendant the price DOES include attendantʼs airfare
from most major airports.) We will ticket air travel
for you and bill you approximately 30 days prior to
the tour.
Pumpernickel Places is operated as a component of My Vacation, Inc, a sister company of
Search Beyond Adventures, Inc. Banking and
accounting are separate, however, so please use
the attached application and make checks
payable to “Pumpernickel Places”.
Autumn 2017 - Summer 2018 Pumpernickel Places
Disney/Universal Florida
6 days!
Las Vegas
 Meet Micky and friends at Disneyʼs Magic
Kingdom
 Explore the rides, shows, and exhibits at
one of the other three Disney parks
 Enjoy the entertainment and food at a dinner show
 Thrill at the shows and rides at Universal
Studios
 Be entertained at two different Las Vegas
shows
 Check out M&M World and other sights on
the “strip”
 Win or lose money at some of the exciting
casinos
Ratios & Prices: Sept. 2-7, 2017
1:2- $1955 1:1, your attendant- $2495
1:1, our attendant- $2695
1:2- $2465
1:1, your attendant- $2820
1:1, our attendant- $3060
Ratios & Prices: Nov. 4-8, 2017
Washington DC
New Orleans
 Tour some of the Smithonian buildings and
other national musems
 Learn from an escorted tour of the Capitol
 Watch money being made at the Bureau of
Engraving
 Enjoy spring weather as you visit some of
the Mall memorials (eg Jefferson,
Roosevelt, Lincoln, Vietnam War)
 Cruise on the Mississippi River aboard a
riverboat
 Boogie to cajun, zydeco, blues, and jazz
music on famous Bourbon Street
 Tour the New Orleans Aquarium
 Shop at the historic French Market in the
French Quarters
Ratios & Prices: Sept. 23-27, 2017
Ratios & Prices: Oct. 21-25, 2017
1:2- $1970 1:1, your attendant- $2250
1:1, our attendant- $2450
1:2- $1995
1:1, your attendant- $2490
1:1, our attendant- $2690
Autumn 2017 - Summer 2018 Pumpernickel Places
Disneyland California
Disney World Florida
 Enjoy Disneylandʼs parades and rides
 Explore Disneyʼs second theme park,
California Adventure
 Visit and shop at Hollywoodʼs boulevard of
the stars
 Ride through famous Beverly Hills
 Meet Micky and friends at Disneyʼs Magic
Kingdom
 Explore the rides, shows, and exhibits at
one of the other three Disney parks
 Enjoy the entertainment and food at a dinner show
Ratios & Prices: Dec. 9-13, 2017
Ratios & Prices: Feb. 3-7, 2018
Memphis
Las Vegas
 Tour Elvisʼ mansion, Graceland
 Visit Sun Studios where Elvis recorded his
first album
 Tour the Rock and Soul Museum
 Listen to the blues on world famous Beale St
 Learn about Martin Luther King at the
National Civil Rights Museum.
 Be entertained at two different Las Vegas
shows
 Check out M&M World and other sights on
the “strip”
 Win or lose money at some of the exciting
casinos
Ratios & Prices: March 17-21, 2018
Ratios & Prices: April 14-18, 2018
1:2- $1895
1:1, your attendant- $2345
1:1, our attendant- $2595
1:2- $1955 1:1, your attendant- $2515
1:1, our attendant- $2735
Disney/Universal Florida
Nashville
1:2- $1995 1:1, your attendant- $2570
1:1, our attendant- $2780
6 days!
 Meet Micky and friends at Disneyʼs Magic
Kingdom
 Explore the rides, shows, and exhibits at
one of the other three Disney parks
 Enjoy the entertainment and food at a dinner show
 Thrill at the shows and rides at Universal
Studios
Ratios & Prices: May 19-24, 2018
1:2- $1970
1:1, your attendant- $2360
1:1, our attendant- $2575
 Enjoy a performance at the famous Grand
Ole Opy
 Tour the Country Music Hall of Fame
 Attend a musical show at the Nashville
Nightlife Theater, or similar
 Tour RCA Studio B where Elvis recorded
many of his albums
Ratios & Prices: June 16-20, 2018
1:2- $2465
1:1, your attendant- $2840
1:1, our attendant- $3095
1:2- $1875
1:1, your attendant- $2315
1:1, our attendant- $2545
Cape Cod
Niagara Falls & Cleveland
 Ride a train through the woodlands and
cranberry bogs of the Cape
 Take a whale-watching cruise
 Visit lighthouses and the seashore
 Shop at funky Provincetown
 Stop at the John F. Kennedy Memorial
 Ride the Maid of the Mist boat for a close
up view of the falls
 Tour Old Fort Niagara
 See the exhibits at the Aquarium of
Niagara, including sharks and penguins
 Tour the Rock ʻnʼ Roll Hall of Fame
 Explore the Museum of Natural History with
exhibits of Saber-toothed tigers & Mastodons
Ratios & Prices: July 21-25, 2018
1:2- $1980 1:1, your attendant- $2570
1:1, our attendant- $2795
Ratios & Prices: Aug. 18-22, 2018
1:2- $1890 1:1, your attendant- $2330
1:1, our attendant- $2560
(800) 800-9979
Pumpernickel Places
My Vacation, Inc
Registration Form
APPLICANT'S NAME:
TOUR NAME:
TOUR DATES :
S TAFF to PARTICIPANT RATIO:
❑
❑
1:2 ratio (must register two people on same tour)
1:1 ratio (bringing own attendant)
❑
1:1 ratio (using Pumpernick el attendant)
GENERAL INFORMATION: (Pl ease Pri nt!)
Age: ____________
Birthdate: __________________
Gender: Male_______ Female____
Preferred Airport: ___________________
If home address is different from agency address to which address should trip information be sent? ❑ Home ❑ Agency ❑ Address is Same
Home Street: _______________________________ City: __________________ State: _____ ZIP: _________ Phone: (____)_________
If you would like tour information faxed or e-mailed to you: Fax Number: (____)_______________ E-Mail: _______________________
Type of Living Situation (check one): ❑ Family ❑ Community Residence ❑ Superv. Apt. ❑ Indep. Living ❑ Other____________
Agency Name: ________________________________________________ Phone: (____)________________ Contact: _______________
Agency Address (if different from home address): Street: ___________________________ City: _____________ State: ____ ZIP: _______
Agency Fax: (____)____________
Emergency phone # (for nights or weekends): (____)__________________________________
Whom do we contact in case of emergency? (include night or weekend contact name) ______________________________________________
Person completing this application: ___________________________ Relationship or Title: _______________ Phone: (___)___________
PHYS ICAL INFORMATION:
Blind?_________ Eyeglasses?________ Deaf?_________ Hearing Aid?_________ Dentures?_________ Prosthetic Device?__________
Memory Deficit Disorder?_________ Autism?_________ Diabetic?_________ Language/Communication difficulties ___________________
Fully ambulatory?___________
If no, what aids do you use? Man. Wheelchair_____ Elec. Wheelchair_____ Walker_____ Cane__
Seizures?_________ If seizures, please describe frequency and type: ________________________________________________________
Control of bowel and bladder?_______
If occasional incontinence, please describe below the frequency, times, and treatment:
________________________________________________________________________________________________________
WHEELCHAIR US ERS ONLY:
Is wheelchair manual?
❑
or electric?
❑
If manual chair can you self-propel your chair?
Indicate type of assistance needed for transfers:
❑
one-person pivot
❑
two-person
❑
❑
or do you need to be pushed?
❑
other (explain): ____________________________
Can you support weight while transferring? ❑ yes ❑ no
Comments: __________________________________________________
Please list any other assistant devises you will need to bring on this tour:
____________________________________________________
S PECIAL NEEDS INFORMATION:
Please describe any physical problems or physical disabilities, activity limitations, special equipment needed.
S ELF CARE S KILLS :
Dressing
Bathing
Toileting
Independent
_____
_____
_____
Needs Assistance*
_____
_____
_____
Street Safety
Eating
Hygiene
Independent
_____
_____
_____
Needs Assistance*
_____
_____
_____
*Please describe how much assistance is needed in any of the skill areas listed above:
Terms: Encl ose a mi ni mum of 25 percent deposi t wi th appl i cati on. Bal ance due 45 days pri or to departure.
Make checks payabl e to: “Pumperni ckel Pl aces”
Pumpernickel Places • (800) 800-9979 • Fax: (877) 721-3409
245 E Old Sturbridge Rd • Brimfield, MA 01010