registration opens jan 11

Transcription

WINTER / SPRING
2016 GUIDE
REGISTRATION
OPENS JAN 11
Registration ends 8 days before
the start of the program/event
H E L P I N G
Y O U
“ E N J O Y
L I F E ”
WINTER/SPRING GUIDE
PROGRAMS &
OPPORTUNITIES for
• tots
• youth
• teens
• adults
• adapted &
paralympic
sports
• inclusion
• NASR
WATCH FOR THE SUMMER GUIDE • AVAILABLE MARCH 2016
stay connected • visit our web site and sign up for
e-news to receive the latest info and exclusive offers
CUSTOMER SERVICE • SE HABLA ESPAÑOL
815-987-8800 • rockfordparkdistrict.org/TR
2
this is where the fun begins
About Us
TABLE OF CONTENTS
TR Resources . . . . . . . . . . . . . . . . . . . . . . . 2
The team that delivers fun . . . . . . . . . . . 3
NASR. . . . . . . . . . . . . . . . . . . . . . . . . . . 4–5
Sports & Fitness . . . . . . . . . . . . . . . . . 7–8
Arts & Leisure . . . . . . . . . . . . . . . . . . 9–10
Social Programs . . . . . . . . . . . . . . . 11–16
Adapted Sports. . . . . . . . . . . . . . . . 17–18
Lending Closet . . . . . . . . . . . . . . . . . . . 19
Inclusion Information . . . . . . . . . . 20–21
Registration Information . . . . . . . . . . 22
Annual Information Form . . . . . . . 23–24
Registration Form. . . . . . . . . . . . . . 25–26
Community Resources . . . . . . . . . . . . . 27
Community Events . . . . . . . . . . . . . . . . 28
REGISTRATION
OPENS JAN 11!
Registration ends 8 days before the
start of the program/event
The Therapeutic Recreation Team of the Rockford Park District is committed to providing community
based recreation to promote the development, maintenance, and expression of a meaningful leisure
lifestyle to individuals with disabilities. We deliver our services promoting and/or providing access,
specialty programs, skill development, and inclusive opportunities.
Special thanks
to the Blazer Foundation for
their generous support of
Rockford Park District Therapeutic
Recreation programming!
your resource
Trained and Ready to Play!
The Park District is committed to providing
safe and enjoyable leisure experiences; all
employees are mandated reporters for child
abuse and neglect.
Throughout the year, staff attend various
trainings based on their role.
Trainings may include:
• Sensory integration
• Transfer and seizure training
key to symbols
Watch for these symbols throughout the
guide.
RIDE
RIDE
Participants are asked to bring items
Please bring spending money
• Safe places and standards for play
• Conflict avoidance/crisis prevention
• Cooperative games
• Disability awareness
• Character development
• CPR and First Aid
Bus transportation service available/
offered
Bus transportation service NOT
available/offered
FUN AND ENJOYMENT
FOR EVERYONE!
RPD visual systems
If the use of pictures will benefit your child in
Rockford Park District programs, please contact
the Therapeutic Recreation office, and we will
be happy to set up the communication tool to
meet their individual needs. Visual systems are
available for download at rockfordparkdistrict.org/
therapeuticrecreation/resources
Speakers
One of our trained staff members would be
happy to meet with your organization, social
service agency, or community group to present
information about Rockford Park District services,
offerings, and other disability related topics, such
as disability awareness and program adaptations.
Use us as a resource
The Therapeutic Recreation Team of the Rockford
Park District can answer questions and assist you
in the process of finding appropriate recreational
programs or services to accommodate interests
with an individualized approach; please call the
Therapeutic Recreation office at 815-987-1606 for
more information.
See p 22 for details.
customer service
815-987-8800
3
the team that delivers
FUN!
recreation
coordinators
[JM]
[KD]
STAFF INITIALS
At the end of each program description, you will see initials
— these initials refer to the coordinator of that program.
For additional program information, please contact that
coordinator directly.
[SS]
[PR]
[JM] Recreation Coordinator Jordan McDonald
815-987-1609 • [email protected]
[PR] Recreation Coordinator Paula Reiter
[KD] Recreation Coordinator Kuenzi Dearth, CTRS
[SS] Recreation Coordinator Shannon Schumacher
Welcome Shannon Schumacher!
Shannon has worked seasonally with the Rockford Park District since 2007. She is
a graduate of UW-Madison with a degree in Rehabilitation Psychology. Shannon
has worked with a variety of therapeutic recreation and community recreation
programs as well as Camp to the Future, our partner program with the Rockford
Public Schools. We are excited to have her join our team!
additional
support staff
[Danielle]
[Karin]
Operations Director Danielle Potter
Therapeutic Recreation Manager Karin Kellogg
Special Events & ADA Officer John Beck
[Mariah]
fax
815-987-8877
[John]
online
Operations Assistant Mariah Anast
rockfordparkdistrict.org/TR
NASR
4
NASR AT A GLANCE
NORTHLANDS ASSOCIATION FOR SPECIAL
RECREATION is a cooperative partnership
between the Rockford, Freeport, and Belvidere
park districts (referred to as member districts).
NASR programs are open to any individual with
disability-related special needs such as physical,
mental, and developmental disabilities, and
persons with mental illness, behavior disorders,
visual, or hearing impairments. Member district
residents are invited to participate in specialty/
therapeutic recreation (TR) programs offered
through any member district at the resident
rate. Participation in inclusion services at a
member district other than your own member
district dictates you must pay the non-resident
rate for that specific program. If you would
like specific program information, please
contact Belvidere and Freeport Park
districts directly.
Rockford Park District
Therapeutic Recreation
Look at all the great progra
ms
offered by Freeport and Be
lvidere
park districts! Did you know
that
you can participate in any of
their
specialty programs, and pa
y the
resident rate? Contact the
agencies
directly to get registered!
Dances
Join your friends at NASR – Freeport Park District for an evening of music and dancing! Contact Freeport
Park District to get registered: 815-235-6114 or freeportparkdistrict.org.
rockfordparkdistrict.org • 815-987-8800
Sweetheart Serenade
Shamrock Shake
Belvidere Park District
Special Recreation Dept
4-Seasons Banquet Center, 1100 W Galena Ave,
Freeport, IL 61032
Carl Sandburg Middle School, 1717 W Eby St,
Freeport, IL 61032
Program fee. . . . . . $15.00
Program fee. . . . . . $10.00
belviderepark.org • 815-547-5711
Freeport Park District
Special Recreation Dept
freeportparkdistrict.org • 815-235-6114
AGES
DATES
TIME
DAY
AGES
DATES
TIME
DAY
15+
Feb 5
7:00–9:00 pm
F
15+
March 4
7:00–9:00 pm
F
customer service
815-987-8800
5
NASR
Special Events
Candyland Ball
Freeport Masonic Temple, 305 W Stephenson St
# 315, Freeport, IL 61032
Winter Wonderland
Dinner & Dancing
Transportation: Pick-up point at Showplace 16
(8301 E State St, Rockford).
Transportation: Pick-up point at Showplace 16
(8301 E State St, Rockford).
4-Seasons Banquet Center, 1100 W Galena Ave,
Freeport, IL 61032
NASR Belvidere Facility, 6581 Revlon Dr,
Belvidere
NASR Belvidere Facility, 6581 Revlon Dr.,
Belvidere
Program fee. . . . . . $12.00
Program fee. . . . . . $15.00
Program fee. . . . . . $15.00
AGES
DATES
TIME
DAY
6-10
Feb 12
6:00–8:30 pm
F
Mom and Me Masquerade
This new event is just for moms and their special
young man (10 years of age and younger). Join us at
4-Seasons banquet for a night of dancing, games,
prizes, and celebration! Fee includes admission into
the dance, games, refreshments, and dessert.
Pre-registration is required.
Super Bowl 50 Party
DATES
TIME
DAY
AGES
DATES
TIME
DAY
AGES
DATES
TIME
DAY
6-10
Feb 26
6:00–7:30 pm
F
13+
Feb 7
5:00–9:00pm
Su
8+
Feb 20
6:00–9:00pm
Sa
Save the date! NASR’s Got Talent
AGES
DATES
TIME
DAY
ACTIVITY#
Join us at Riverfront Museum Park for a day full of arts activities!
Activities will include hands-on visual arts, dance workshops, music
activities, theater workshops, and art show. At the end of the day (or
the night before), we will be hosting the NASR’s Got Talent Show. The
event is free to all attendees! For more information, contact Jordan
McDonald at 815-987-1609.
8+
April 30
6:30-9:30 pm
Sa
406146-B1
Riverfront Museum Park: 711 N Main St #7, Rockford, IL
Performers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FREE
Performer
fax
Saturday, April 30
815-987-8877
online
ADAPTED SPORTS
Calling all dancers, singers, actors, comedians, magicians, and anyone who
thinks they’ve got talent — participate in the NASR’s Got Talent Show to
compete against other regional performers for prizes, awards, and a chance
to be a star! There will be refreshments, games, and tons of talent. Audience
members and judges will vote for their favorite acts to determine who will
be this year’s most talented star. Parents/guardians, friends, and family are
encouraged to stay for the show ($1.00 per person donation suggested).
FREE! No Boundaries: Arts Day for
People with Disabilities and their
Friends and Families
SOCIAL
AGES
ARTS & LEIISURE
Join us for our first annual Super Bowl Party!
Wear your team colors and join us as we watch
Super Bowl 50 on the big screen. All participants
will pick a number for the pool to collect cool
prizes to take home. All partygoers who picked
the winning team will win a special prize! Game
day appetizers and sloppy joes will be served for
snacks and dinner.
Dust off those dancing shoes, and dress your best
to walk the red carpet for a night out with your
friends! Girls grab your boys, boys grab your girls,
and get ready to twirl your way into a night of
dancing! Each guest will get to dine in style while
enjoying some Italian cuisine. Guests will also
receive a flower, and have an opportunity to take
a picture with friends to remember this special
night. Formal dress is recommended, but not
required to attend this evening to remember!
Program fee. . . . . . $12.00
SPORTS & FITNESS
Dads (or significant adult), come dance the night
away with your favorite girl(s) at the Masonic
Temple. Here’s the perfect chance to dress up and
feel like royalty for the night! Don’t miss out on this
Freeport tradition for Dads and daughters ten years
of age and younger.
INFO THAT’S GOOD TO KNOW
6
Parents — need a place
for the kids to burn off some
energy after school?
Peer Play
e-mail
This after school program provides an inclusive opportunity utilizing the YMCA School
Age Center Program as its main source of fun. Participants will make new friends
while participating in the following activities: arts and crafts, health and fitness,
active games, and playing on the playground. They will also be given the chance to
spend time on their homework; a daily snack will be provided. Participants should use
Septran to get to the site, and parents/guardians should pick up at the site between
5:00 and 5:30 pm. Program follows the school calendar. Contact 815-987-1626 or
[email protected] for locations and availability. [KD]
Contact us
today for more
information!
call
customer service
815-987-8800
7
See p 22
for details.
TUES
THURS
FUN AND
ENJOYMENT
FOR EVERYONE!
815-987-8877
TEEN
ADULTS
5–12
13–21
22+
PROGRAM
TIME
PAGE
Adapted Aquatics
see YMCA guide
8
AquaFitness
see YMCA guide
8


Walking Club
6:00-7:00 pm
8


Buddy Basketball
times vary
8
PLEASE NOTE: times are subject to change based
on actual enrollment
fax
YOUTH
3-18
8-12

SPORTS & FITNESS
SPORTS & FITNESS
AT A GLANCE
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
NASR
8 SPORTS & FITNESS
check out this guide
for inclusion opportunities
throughout the Park District
Adapted Aquatics
Swimming Lessons
One-on-one instruction is offered for the price of a group lesson. Please
see the online YMCA guide (rockriverymca.org » click on Programs) or call
815-885-6810 for more information.
ID Pennock YMCA Family Branch, 200 Y Blvd, Rockford, IL
Northeast YMCA Family Branch, 8451 Orth Rd, Loves Park, IL
AGES
DATES
3-18
Jan 11-Feb 21
TIME
DAY
See YMCA guide
Buddy Basketball is a non-competitive recreational league. Players with
a disability related need are placed on a team with “buddies” to assist in
creating a fun and successful opportunity as a valuable team player. The
program focuses on experience of team play, exposure to a lifelong leisure
skill, and participation. [SS]
Note: B uddy training will be held March 3 at First Free Church from 6:00 to
8:00 pm.
First Free Church, 2223 N Mulford Rd, Rockford, IL
Resident. . . . . . . . . $40.00Non-resident. . . . . $50.00
Buddies . . . . . . . . . . . free
AquaFitness
AGES
DATES
TIME
If interested, please contact Karin Kellogg at
[email protected] or 815-987-1601. You will be
contacted when the details of the program are available.
8–12
March 10-April 28
6:00-6:50 pm
Th
406154-01
13–21
March 10-April 28
7:00-7:50 pm
Th
406254-01
16-25
Th
406254-BB
AGES
ADAPTED SPORTS
Buddy Basketball
13+
DATES
TIME
TBA
DAY ACTIVITY#
Buddy registration info
March 3-April 28
6:00-7:50 pm
DAY
Walking Club
Lace up your walking shoes and join us for Walking Club! Let’s walk away
a few extra pounds while visiting with friends and enjoying nature at
Dahlquist Park. We will keep track of our laps, and tally them at the end of
each night to give us a goal to work toward the next week. [SS]
Dahlquist Park, 6251 Oak Grove Ave, Rockford
AGES
DATES
TIME
13+
April 5-May 17
6:00–7:00 pm
customer service
815-987-8800
DAY ACTIVITY#
Tu
506355-21
9
PROGRAM REGISTRATION OPENS JAN 11!
TOTS
YOUTH
TEEN
ADULTS
3–5
6–12
13–19
20+
PROGRAM
TIME
PAGE
Green Thumb Gardening
6:00–7:15 pm
10

Edible Creations
6:00–8:00 pm
10

Art at the Arc —
Open Studio
1:00–3:45 pm
10
18+

Art at the Arc —
Skills Class
4:00–5:30 pm
10
18+

Edible Creations
6:00–8:00 pm
10
Art at the Arc —
Open Studio
1:00–3:45 pm
10
18+

Art at the Arc —
Skills Class
4:00–5:30 pm
10
18+

Chance to Dance
times vary
9





ARTS & LEISURE
AT A GLANCE
Chance to Dance
The Rockford Park District and the Rockford Dance Company have teamed up to provide this
semester-long dance program for youth with disabilities. The class is a technique-based
dance program that lets participants explore creative expression in a non-judgmental
setting, creating an enjoyable opportunity for expressive movements. Learn basic dance
skills, rhythm, and creative expression in a real dance studio. Please wear movable clothing
such as sweat pants, t-shirts, and soft dance shoes (or go barefoot, but no socks, please).
Parents are encouraged to stay and watch from the observation rooms. [SS]
Rockford Dance Company in Riverfront Museum Park, 711 N Main St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
3–12
Feb 6-March 12
10:30–11:20 am
Sa
406142-11
13-17
Feb 6-March 12
10:30–11:20 am
Sa
406242-11
18+
Feb 6-March 12
11:30 am–12:20 pm
Sa
506342-11
fax
815-987-8877
online
ARTS & LEISURE SKILL DEVELOPMENT
SAT
THURS
WED
Registration ends 8 days before the start of the program/event
Edible Creations
Art at the Arc – Skills Class
Looking for great chefs! Would you like to learn to cook and increase
independence in the kitchen? The menus are still simple and still delicious.
We will work on our cooking and safety skills and knowledge. [PR]
Are you an artist? Have you always wanted to be one? Then you need to join
Art at the Arc! This collaborative program between the Rockford Park District
and the Arc of Winnebago, Boone, and Ogle Counties provides its artists with
the proper supplies and facility to practice their creative skills. Artists will
learn a new skill to try out each week as well as creating their very own art
piece. Be sure to wear clothes that you don’t mind getting messy. [JM]
Linda K White Center, 623 N Alpine Rd, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
NOTE: Registration is limited to one class per week.
20+
March 2-23
6:00–8:00 pm
W
506331-31
20+
March 3-24
6:00–8:00 pm
Th
506331-32
The Arc, 1222 E State St, Rockford, IL
20+
March 30-April 20 6:00–8:00 pm
W
506331-41
20+
March 31-April 21 6:00–8:00 pm
Th
506331-42
ADAPTED SPORTS
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
NASR
10 ARTS & LEISURE
AGES
DATES
TIME
DAY
ACTIVITY#
18+
Feb 3-24
4:00–5:30 pm
W
506340-21
18+
Feb 4-25
4:00–5:30 pm
Th
506340-22
18+
March 2-23
4:00–5:30 pm
W
506340-31
18+
March 3-24
4:00–5:30 pm
Th
506340-32
18+
March 30-April 20
4:00–5:30 pm
W
506340-41
18+
March 31-April 21
4:00–5:30 pm
Th
506340-42
Art at the Arc – Open Studio
Open Studio is an ideal program for artists that have participated in our
Skills classes but are now looking for a creative environment to work
independently on their own artwork. Artists will receive guidance from staff
artists on how to develop artistic skills, content, and professionalism. Artists
must have participated in the Skills classes previously to participate in Open
Studio. Basic supplies will be provided, but artists are encouraged to bring
additional supplies. Artists will have an opportunity to sell their artwork;
proceeds will go to the artist and the program. [JM]
FUN AND ENJOYMENT FOR EVERYONE!
NOTE: Artists must have participated in the Skills classes previously to
qualify for the Open Studio. If interested, please contact Jordan McDonald
at 815-987-1609.
See p 22 for details.
The Arc, 1222 E State St, Rockford, IL
Green Thumb Gardening
The weather is warmer, the days are longer, and its time to dig in! We’ll add
our own personal touches to the Linda K. White Center by planting flowers
and vegetables. After we’re done planting, we’ll help maintain our landscape
designs and make some crafts for our gardens at home. [PR]
AGES
DATES
TIME
DAY
18+
Feb 3-24
1:00–3:45 pm
W
18+
Feb 4-25
1:00–3:45 pm
Th
18+
March 2-23
1:00–3:45 pm
W
18+
March 3-24
1:00–3:45 pm
Th
AGES
DATES
TIME
DAY
ACTIVITY#
18+
March 30-April 20
1:00–3:45 pm
W
20+
May 4-25
6:00–7:15 pm
W
506332-51
18+
March 31-April 21
1:00–3:45 pm
Th
customer service
815-987-8800
ADULTS
13–19
20+
PROGRAM
TIME
PAGE
Be Social: Festive Friday Night Cooking
6:00-8:00 pm
14

Be Social: IceHogs Game
6:30–10:00 pm
14

Be Social: Rock Valley College Basketball Game
2:30-4:30 pm
14

Be Social: Valentine’s Day Dance
6:30–9:00 pm
15

Be Social: Guys Night
6:30–9:00 pm
15

Be Social: St Patrick’s Day Dance
6:30–9:00 pm
15

Be Social: Fitness and Fun at the YMCA
6:30–9:00 pm
15

Be Social: Gerry’s Pizza
7:00–9:00 pm
15

Be Social: National Earth Day
6:30–9:00 pm
16

Be Social: Girls Night
6:30–9:00 pm
16

Be Social: Gifts Galore
6:30–9:00 pm
16

Teens on the Town: Snow Tubing at Alpine Hills
1:00–3:00 pm
12

Teens on the Town: Movie Matinee
1:00–3:00 pm
12

Teens on the Town: Bowling
1:00–3:00 pm
13

Teens on the Town: Culver’s and Nickel World
12:00-2:20 pm
13

Be Social: Spring Craft
1:00–3:00 pm
15

Be Social: Bowling
1:00–3:00 pm
15

Be Social: National Picnic Day
12:00-2:30 pm
16

Teens on the Town: NASR’s Got Talent Audience
6:30-9:30 pm
13
Be Social: NASR’s Got Talent Audience
6:30-9:30 pm
16
SAT
FRI
TEEN


PROGRAM REGISTRATION
OPENS JAN 11!
fax
815-987-8877
online
See pg 4 for additional
social opportunities
SOCIAL
SOCIAL PROGRAMS
AT A GLANCE
Registration ends 8 days before the start of the program/event
11
12 SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
NASR
Teens on the Town
The Therapeutic Recreation team’s social program provides adults (Be Social)
and teens (Teens on the Town) with events to hang out with their friends.
Some of the events are housed within the Rockford Park District facilities.
These events include seasonal dances, karaoke nights, game nights (video
and board games), movie nights, craft opportunities, and cooking programs,
to name a few. When we “hit the town,” we’ll check out community sporting
events (IceHogs, Rockford Aviators, Rock Valley College basketball), the local
museums, movies, bowling, go out to eat, visit favorite parks for picnic fun,
and of course, hang out at some of our favorite RPD spots (Forest City Queen,
Magic Waters, the pools, Lockwood Park, etc.). We’re also open to suggestions.
If you’re looking to get out on the town to be social, give us a call! [PR]
Locations vary by program
FEE FOR EACH PROGRAM, UNLESS OTHERWISE LISTED
Cancellation policy: Full refunds will be granted for any registration
cancelled by the participant two weeks prior to the start of the
program. If the program you have registered for is cancelled, a full
refund will be issued. If the program fee includes an event ticket, and
the tickets have already been purchased, your refund will be pro-rated
to cover the cost of the ticket.
Transportation • $4.00 per social event
•Residents: We provide door-to-door transportation for participants
who are Rockford Park District residents.
•Non-residents: Pick-up points are available for participants
who are non-residents. Please choose one of the following
pick-up points
• North Pick-up Point — the northwest corner of
Meadow Mart Shopping Center (N Second St and
Windsor Rd, Loves Park)
• South Pick-up Point — Phillips 66 (4402 Linden Rd, Rockford)
•You can also choose to bring your participant to the location of each
social event; you DO NOT have to use transportation services.
Registration Deadline
•Please also note, the registration deadline is eight business days prior
to the event.
•To be officially registered, a program registration form must be
completed and signed. Payment must also be made at the time of
registration.
•If you have extenuating circumstances and cannot register your
participant prior to the deadline, contact the Therapeutic Recreation
office at 815-987-1606 as soon as possible.
ADAPTED SPORTS
SOCIAL
Snow Tubing at Alpine Hills
RIDE
Grab your gear, we are going snow tubing at Alpine Hills Adventure Park!
Join us for a fun-filled afternoon of playing in the snow and tubing down the
great hills. We will warm up in the clubhouse with hot chocolate and snacks.
Alpine Hills Park, 4401 Larson Ave, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
Jan 30
1:00–3:00 pm
Sa
406221-11
Movie Matinee
RIDE
Let’s go the movies! Grab your friends and join us for the newest flicks at the
AMC Theater. Movie will be determined on Thursday before program date,
and will not be rated higher than PG-13. Please bring money for concessions
($5.00 to $10.00 recommended).
Showplace 16, 8301 E State St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
Feb 27
1:00–3:00 pm
Sa
406221-21
customer service
815-987-8800
13
Bowling
RIDE
NASR
Lace up those bowling shoes, it’s time to roll! We will bowl two games, and
enjoy a snack at the bowling alley. Shoes, balls, and ramp will be provided,
but feel free to bring your own. Please bring money for concessions ($5.00 to
$10.00 recommended).
Showplace 16, 8301 E State St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
March 12
1:00–3:00 pm
Sa
406221-31
RIDE
NASR’s Got Talent Audience
RIDE
Round up your friends for an afternoon of fun! We will grab lunch at Culver’s,
then head over to Nickel World to play video and arcade games. Twenty
tokens will be provided for game play. Please bring money for lunch and
additional tokens ($10.00 to $15.00 recommended).
Join us as Be Social becomes part of the audience for the NASR’s Got Talent
show. We will get the chance to watch various performances including
dancing, singing, and acting, then vote for our favorite. Snack and drinks will
be provided.
Nickel World, 3321 N Main St, Rockford, IL
Per audience member . . . . . . . . . . . . . . $1.00 suggested donation
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
April 9
12:00-2:30 pm
Sa
406221-41
13–19
April 30
6:30-9:30 pm
Sa
506322-49
ARTS & LEIISURE
AGES
SPORTS & FITNESS
Culver’s and Nickel World
SOCIAL
ADAPTED SPORTS
fax
815-987-8877
online
14 SOCIAL
PROGRAM REGISTRATION OPENS JAN 11!
ARTS & LEISURE
SPORTS & FITNESS
NASR
Registration ends 8 daysbefore the start of the program/event
Be Social
The Therapeutic Recreation team’s social program provides adults (Be Social) and teens (Teens on the
Town) with events to hang out with their friends. Some of the events are housed within the Rockford
Park District facilities. These events include seasonal dances, karaoke nights, game nights (video and
board games), movie nights, craft opportunities, and cooking programs, to name a few. When we “hit
the town,” we’ll check out community sporting events (IceHogs, Rockford Aviators, Rock
Valley College basketball), the local museums, movies, bowling, go out to eat, check out
our favorite parks for picnic fun, and of course, hang out at some of our favorite RPD
spots (Forest City Queen, Magic Waters, the pools, Lockwood Park, etc.). We are also open
to suggestions. If you’re looking to get out on the town to be social, give us a call! [PR]
Locations vary by program
FEE FOR EACH PROGRAM, UNLESS OTHERWISE LISTED
Festive Friday Night Cooking
RIDE
Calling all chefs! Join us for a night of cooking as we prepare a great meal
from scratch. Once we make our delicious creation, we will enjoy our meal
with our friends. There will even be a comedy movie to enjoy while we cook.
SOCIAL
RIDE
Watch the Rock Valley College Golden Eagles as they slam dunk on their
opponent! We will cheer on our team as they dribble home a victory!
Please bring money for concessions ($5.00 to $10.00 recommended).
NOTE: Registration is limited to one date.
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Jan 29
6:00-8:00 pm
F
506322-11
Rock Valley College, 3301 N Mulford Rd, Rockford, IL
20+
March 11
6:00-8:00 pm
F
506322-33
IceHogs Game
ADAPTED SPORTS
Rock Valley College Basketball Game
RIDE
Come cheer on Rockford’s very own hockey team, the Rockford IceHogs, as
they skate across the ice to put another “W” on their record. Please bring
money for concessions ($10.00 to $15.00 recommended).
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Feb 6
2:30-4:30 pm
Sa
506322-22
20+
Feb 20
2:30-4:30 pm
Sa
506322-25
key to symbols
Watch for these symbols throughout the guide.
BMO Harris Bank Center, 300 Elm St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Feb 5
6:30-10:00 pm
F
506322-21
20+
Feb 19
6:30-10:00 pm
F
506322-24
RIDE
RIDE
Please bring spending money
Bus transportation service available/offered
Bus transportation service NOT available/offered
customer service
815-987-8800
SOCIAL 15
Valentine’s Day Dance
NASR
See pg 4 for additional
social opportunities
RIDE
Watch out for Cupid’s arrow as you dance the night away! Love will be in the
air on this very special night of music and dancing. Snacks and beverages will
be provided.
Fitness and Fun at the YMCA
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Feb 12
6:30-9:00 pm
F
506322-23
Guys Night
Join us for an evening of fitness and fun activities at the downtown YMCA.
We will have the opportunity to rock climb, walk on the indoor track, shoot
hoops, try out the exercise equipment, or take a dip in the pool.
RIDE
AGES
DATES
TIME
DAY
ACTIVITY#
20+
March 4
6:30-9:00 pm
F
506322-31
RIDE
Spring is in the air! Come help us welcome it with some fun crafts to take
home. Weather permitting, we will take a nature hike through the beautiful
park.
AGES
DATES
TIME
DAY
ACTIVITY#
20+
March 25
6:30-9:00 pm
F
506322-35
20+
April 15
6:30-9:00 pm
F
506322-43
Gerry’s Pizza
RIDE
This is not an April Fools’ joke, we are going out to dinner at Gerry’s Pizza!
Delicious pizza, spaghetti, and ravioli are some of the great menu choices.
Join us for a great night of food, friends, and fun! Please bring money for
dinner, drink, and tip ($15.00 to $20.00 recommended).
Gerry’s Pizza, 7403 Argus Dr, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
April 1
7:00-9:00 pm
F
506322-41
AGES
DATES
TIME
DAY
ACTIVITY#
Bowling
20+
March 5
1:00-3:00 pm
Sa
506322-32
20+
April 16
1:00-3:00 pm
Sa
506322-44
Lace up those bowling shoes, it’s time to roll! We will bowl two games,
and enjoy a snack together. Shoes, balls, and ramps will be provided,
but feel free to bring your own. Please bring money for concessions
($5.00 to $10.00 recommended).
RIDE
Everyone’s Irish on St. Patrick’s Day, so don your kelly green, it’s time to
shamROCK and ROLL!
Webbs Norman Center, 401 S Main St, Rockford, IL
RIDE
Park Lanes, 5318 N Second St, Loves Park, IL
AGES
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
20+
April 2
1:00-3:00 pm
Sa
506322-42
20+
March 18
6:30-9:00 pm
F
506322-34
20+
May 7
1:00-3:00 pm
Sa
506322-52
ADAPTED SPORTS
St Patrick’s Day Dance
SOCIAL
ARTS & LEIISURE
Guys — need a break from the ladies? Enjoy a fun night of card games,
board games, sports, and movies with just the guys. We will serve meatball
po’boy sandwiches, chips, and rootbeer floats for dinner.
Spring Craft
RIDE
SPORTS & FITNESS
Webbs Norman Center, 401 S Main St, Rockford, IL
ARTS & LEISURE
SPORTS & FITNESS
NASR
16 SOCIAL
Girls Night
Oh, those girls just want to have fun, and that’s exactly what we’ll do! There
will be music, make-up, nails, facials, crafts, and more! We will even spend
some time making a sweet treat to enjoy. What a great way to spend time
with the girls!
National Earth Day
SOCIAL
RIDE
It’s National Earth Day! Let’s celebrate our beautiful home by getting
together at Aldeen Park for an evening of fun. We will have a “nature”
scavenger hunt, make a cool recycled craft to take home, and make some
yummy snacks.
AGES
DATES
TIME
DAY
ACTIVITY#
20+
April 29
6:30-9:00 pm
F
506322-47
NASR’s Got Talent Audience
NOTE: Registration is limited to either Friday’s Earth Day activities OR
Saturday’s National Picnic Day activities (see below).
RIDE
AGES
DATES
TIME
DAY
ACTIVITY#
Join us as Be Social becomes part of the audience for the NASR’s Got Talent
show. We will get the chance to watch various performances including
dancing, singing, and acting, then vote for our favorite. Snack and drinks will
be provided.
20+
April 22
6:30-9:00 pm
F
506322-45
Per audience member . . . . . . . . . . . . . . $1.00 suggested donation
National Picnic Day
ADAPTED SPORTS
RIDE
RIDE
It’s National Picnic Day, and that is just what we will do! Join us at Aldeen
Park for a wonderful picnic lunch specially prepared for us. We will also enjoy
a nature walk and outdoor games.
AGES
DATES
TIME
DAY
ACTIVITY#
20+
April 30
6:30-9:30 pm
Sa
506322-49
Gifts Galore
RIDE
NOTE: Registration is limited to either Friday’s Earth Day activities OR
Saturday’s National Picnic Day activities (see above).
Mother’s Day is right around the corner, so let’s get together and make a
special gift. We will be painting and planting flower pots for you to take
home and give to that special someone.
AGES
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
20+
April 23
12:00-2:30 pm
Sa
506322-46
20+
May 6
6:30-9:00 pm
F
506322-51
Serving the
community for
over 40 years
customer service
815-987-8800
17
Welcome
Dave Reiter,
head coach
of the
Jr. Chariots!
Adapted Sports and Paralympic Sports
We are pleased to announce
David Reiter as the new head
coach for the Rockford Junior
Chariots. David has many years
of experience in sports through
coaching, officiating, and
sports program development.
He has 25 years of experience
and involvement with the
National Wheelchair Basketball
Association through officiating,
and is currently helping the
development of the NWBA
college division. David has a real
passion for adapted sports and
the Junior Chariots program!
Beginner to advanced athletes are invited to participate in Adapted Sports to find out, What’s Your Game?
These programs are geared toward introducing players to the wonderful world of sports. Athletes
can choose to participate at the level where they are comfortable … recreationally or
competitively. Interested families are encouraged to call for more details about each
program.
Eligible players include children and adults who:
•have mobility needs (may or may not use a wheelchair on a daily basis)
• are visually impaired
• have an amputation
WED TUES
•have a neurological/muscular impairment, such as cerebral palsy, spina bifida and others, including
those with orthopedic impairments, permanent knee injuries, and leg length discrepancies.
YOUTH
TEEN
ADULT
20+
PROGRAM
TIME
PAGE
6–12
13–19
Wheelchair Basketball
6:15–8:15 pm
18
6+
through
high school
(HS)
Paralympic Boccia
4:00–6:00 pm
18


fax
815-987-8877
online
ADAPTED SPORTS
ADAPTED SPORTS
AT A GLANCE
18 ADAPTED SPORTS
NASR
The Rockford Park District has been named an official Paralympic Sport
Club. The Paralympic Sport Club will provide an excellent opportunity to
connect organizations to new audiences, increase sports and physical activity
opportunities, and raise the profile of Paralympic Sports nationally.
ARTS & LEISURE
SPORTS & FITNESS
Wheelchair Basketball
Paralympic Boccia
Boccia can be played by beginners or strategy-oriented competitors! Come
learn the rules and strategies. Athletes practice to compete at tournaments
in the Chicagoland area. [PR]
NOTE: Weekend tournaments played; dates to be determined.
SOCIAL
Indoor Sports Center (ISC), 8800 E Riverside Blvd, Loves Park, IL
Indoor Sports Center (ISC), 8800 E Riverside Blvd, Loves Park, IL
Res player. . . . . . . . $60.00 Non-res player. . . . $84.00
Res player. . . . . . . . $24.00 Non-res player. . . . $34.00
AGES
DATES
TIME
DAY
ACTIVITY#
13+
March 2-May 4
4:00–6:00 pm
W
606461-31
JOIN
THE NATIONALLY RECOGNIZED
ADAPTED SPORTS
RIDE
ROCKFORD
JUNIOR
CHARIOTS
BASKETBALL TEAM
Join the Jr. Chariots Wheelchair Basketball team for another great season.
Whether you are just beginning, or have been playing for years, we
have the opportunity for you. The team practices at the “Junior” division
standards level of the National Wheelchair Basketball Association. Weekend
tournaments and games are offered throughout the season. The game
schedule will be given out at practices. Contact Jordan McDonald at
815-987-1609 for more information. [JM]
AGES
DATES
TIME
DAY
ACTIVITY#
6–21
Sept 29, 2015–
April 12, 2016
6:15–8:15 pm
Tu
606460-A1
DID YOU
KNOW?
T o qualify to play wheelchair
basketball, you do not need
to use a wheelchair for daily
use. An athlete must have a
permanent physical limitation
of the lower limb that prevents
them from being able to run,
jump, or pivot with the same
control and stability as a
non-disabled athlete.
In 2014, the Rockford Junior
Chariots were NWBA Junior
Division National Champions.
heelchair basketball
W
helps an athlete develop
self-esteem, teamwork, and
physical development as well
as providing opportunities for
advancement in college and
beyond.
customer service
815-987-8800
LENDING CLOSET 19
If you don’t have it, don’t worry …
we probably do!
Ask about our Lending Closet, available to anyone in the community looking to try a
new sport or use new equipment. See the detailed list of equipment below; available
on a first come, first served basis.
• sports wheelchairs
• all-terrain joggers
•bicycles
• bowling ramps
• hand cycles
• power soccer equipment
•tricycles
Schools
Contact us for use of adapted equipment
in your classroom.
Don’t let accessibility
be what holds you back!
Many of our facilities provide equipment to
enhance your experience at our facilities at
no cost.
water wheelchairs
• available at Magic Waters
•available to take to the beach or other
swimming pool
accessible golf cart
•for use at any RPD golf course; please
contact the course 48 hours in advance
ice hockey sleds
•for use during public skate sessions, or to
try the sport of sled hockey
ice skating walkers
• for use during public skate sessions
Call the Therapeutic Recreation department
at 815-987-1606 for more information.
fax
815-987-8877
online
20
inclusion services
I
nclusion within the Rockford Park
District means individuals with disabilities
are welcome to participate in the same
recreation programs and activities as their
peers. Reasonable accommodations are
provided to enable an individual’s
successful participation in a program.
INCLUSION SUPPORT IS A TEAM EFFORT:
The Rockford Park
District welcomes and
supports the participation
of individuals with
disabilities in all programs
and services.
Popular programs in
which individuals with
disabilities
have been included:
• Lessons (swimming,
hockey, ice skating,
horseback riding,
tennis, golf)
• Day and overnight
summer camps
(Summer Blast, Nature
Quest, Camp Lone Oak,
Pony Camp)
• Neighborhood
programs (playgrounds,
Lewis Lemon and
Washington Park
community centers)
• Environmental
education and
recreation
• Youth sports
• After school programs
• Consultation on activity
modification
• Disability awareness
training
• Behavior modification
support
• Observation and
evaluation
• Visual systems and
sensory equipment/toys
• Sign language
communicators
• Adapted equipment
(sleds, skate walkers,
hand cranked bicycles,
sport wheelchairs)
• Varying levels of
disability-trained
staff support
Inclusion Services has
created successful
inclusion opportunities by:
• Implementing a positive
support plan for a child
with a conduct disorder
in a full day summer
camp setting.
• Providing an all-terrain
wheelchair for a student
with a physical disability
for full trail access at
Atwood Center.
• Trained staff supporting
a camper with an
attention deficit
disorder by providing
additional supports
such as redirection and
positive reinforcements
at soccer camp.
• Providing a sign
language communicator
for a teen at horseback
riding lessons.
Parent/Guardian
TR Coordinator
Program Director
Inclusion Staff
Participant
Parent/guardian of an
individual who has a
health and/or disability
related need
Coordinator who
is responsible
for coordinating
and developing
inclusive supports
Recreation staff/director
who runs and oversees
registered for program
Staff trained and
employed by
TR department
Provide TR coordinator
with program info
Contact parent/guardian
within 48 hours
of registration
▼
Meet with TR coordinator
to learn about participant
and support(s)
RPD participant
who needs additional
support to successfully
participate in program
Indicate participant has a
health/disability related
need during registration
▼
Complete an Annual
Information Form
▼
Openly communicate
with the TR Coordinator.
Provide Input on needed
supports and goals.
Determine appropriate
start date and level of
support (NOTE: consider
program environment,
participant assessment,
parent goals, and
available supports)
▼
▼
Communicate absences,
feedback on supports,
inclusion efforts, and
participant experience
Contact parents to share
determined start dates
and support(s)
▼
▼
Communicate info
and supports to program
and inclusion staff
▼
Monitor participants’
progress and modify
supports as needed
▼
Meet with TR coordinator
to learn about participant
and supports
Meet program
registration
requirements (i.e. age,
pre-requisites, etc.)
▼
Implement support(s)
as determined by
TR coordinator
Implement support(s)
▼
▼
Work and communicate
with program staff
and TR coordinator to
support participant
Follow program/facility
rules with
determined support
▼
▼
Consistently and openly
communicate with
parent(s)/guardian(s) on
participant’s progress
HAVE FUN!
Communicate with
TR coordinator and
inclusion staff to help
support participant
▼
Consistently and openly
communicate with
parent(s)/guardian(s) on
participant’s progress
▼
Participate on
determined start dates
▼
For additional information, please contact:
Kuenzi Dearth, CTRS
customer service
815-987-8800
21
Hear what people are saying about Inclusion Services, and how it is changing the lives of our residents.
“We are so grateful for this program; it is the only summer program I can
send my son to and have peace of mind knowing the staff can handle my
son’s issues. The staff did everything they could to make it a successful
experience.”
“The Inclusion staff were great, super enthusiastic, high energy, and
great communication.”
“My son has a great summer having the ability to participate in golf and tennis.
I am truly at ease when he is there because of the level of understanding that
the staff have. Thank you so much!”
For additional questions, contact Inclusion Services at 815-987-1626,
or e-mail [email protected]
Therapeutic Recreation –
Buddy Baseball/Basketball –
Check out this guide for inclusion
opportunities throughout the
Park District.
Accessibility–Compliance and Grievance Process
We welcome the opportunity to assist guests with disabilities to enjoy ALL our facilities, programs, and
services. For assistance and information on accessibility, contact the Therapeutic Recreation team at
815-987-8800, or indicate your disability-related need on your registration form.
The Rockford Park District is a public entity as defined under Title II of the Americans with Disabilities Act
(ADA) which prohibits the District from discriminating against qualified individuals with disabilities in all
programs, activities, and services. The Rockford Park District is committed to complying with all applicable
provisions of Title II as well as all other federal and state laws and regulations pertaining to persons with
disabilities.
Any person or authorized representative who believes that the Rockford Park District has discriminated
against them based on their disability by denying access to its programs and services, may file a formal
grievance with the Rockford Park District’s ADA Compliance Officer. For more information, please visit
rockfordparkdistrict.org/AllAccess or submit your concern in writing within 30 days to:
John Beck, Rockford Park District, 401 S. Main St., Rockford, Illinois 61101
fax
815-987-8877
online
TITLE VI As the Rockford Park District has
received financial assistance in the form of Land
and Water Conservation assistance, the U.S.
Department of the Interior, under Title VI of the
Civil Rights Act of 1964, prohibits discrimination
on the basis of race, color, national origin,
age, or disability. If you believe you have been
subjected to discrimination in any program,
activity, or facility, or you desire further
information regarding Title VI, please write to:
Office for Equal Opportunity, U.S. Department of
the Interior, Washington, DC, 20240
INCLUSION SERVICES
check us out on facebook!
22
registration information
4 convenient ways to register
1. REGISTER ONLINE at www.RockfordParkDistrict.org.
Click on “My RPD” for details
REGISTRATION INFORMATION
EZ Pay Plan
We offer an installment payment plan for select programs, which
automatically withdraws payments from your bank account or charges
payments to your credit card. Call 815-987-8800 to make arrangements.
2.MAIL your registration form and payment to
ROCKFORD PARK DISTRICT ATTN CUSTOMER SERVICE
401 S MAIN ST STE 109 ROCKFORD, IL 61101-1321
3. FAX your form (credit card only) to 815-987-8877
Fee Assistance
4. REGISTER IN PERSON at our Customer Service locations
WEBBS NORMAN CENTER 401 S. Main Street, Rockford
OFFICE HOURS Mon–Fri, 8:30 am–5:00 pm
CARLSON ICE ARENA Perryville and Riverside, Loves Park
OFFICE HOURS Mon–Fri, 8:00 am–8:00 pm; Sat, 8:00 am–12:00 pm
Program Registration
REGISTER EARLY! Registration ends 8 days prior
to the start of the program or event. If you register
after the deadline, your registration will be held
until we can determine if accommodations for
the participant can be made. Accommodations
include assessment of individual’s needs,
requirements of the program, space limitations,
staffing, and where appropriate, transportation
capacity.
We also have minimum requirements to have a
program run. Due to low enrollment, a program
may be cancelled.
TR Assessment/Annual
Information Form (AIF)
To better serve you or your child’s needs, it
is necessary for us to have a current AIF on file
in our office. This form contains medical and
other information that ensures individual
success in the program and provides essential
emergency information.
PHOTOS
On occasion, the Rockford Park District staff
may photograph or videotape participants
during Park District programs/classes, events,
fax 815-987-8877
Fun and enjoyment
for everyone
Please make checks payable to the Rockford Park District.
815-987-8800
People with disabilities of all ages who
meet fee assistance guidelines, and are
residents of the Park District, may be eligible
for the “Help Me Play” fee assistance program.
Call 815-987-8800 for more information.
or at our facilities. These photos may be used in
Park District publications, advertisements, videos,
or on our web site. If you or your child do not
wish to be photographed, please step away
from the camera or notify the photographer.
Information you
need to know
Program Drop-off
and Pick-up
For the safety of all participants, parents must
personally check in with a program leader when
dropping off and picking up their participant.
Individuals picking up participants will be asked
to show a photo I.D. Participants may be dropped
off no more than 10 minutes prior to the start of
the program.
Late Pick-up Policy
If parents/guardians are not on time for picking
up participants, a late fee will be assessed. A
$5.00 fee will be invoiced for every 5 minutes.
Continued tardiness could result in possible
dismissal from the program.
customer service
Medication Procedures
The Rockford Park District strongly encourages
participants’ self-responsibility for their personal
health, including personal care and medications.
We ask that whenever possible, participants
take their medication before or after, rather than
during programming. Please understand that the
Rockford Park District will administer medication
for youth under the age of 18 and/or participants
enrolled in our Therapeutic Recreation specific
programs only in situations that are absolutely
necessary for a participant’s health, and which
fall under the Americans with Disabilities Act
and District guidelines.
In order for staff to administer medication,
parents/guardians must complete the
appropriate forms.
TR GUIDE ACCURACY Every effort has been
made to assure the accuracy of information
contained within this Guide. However, errors
can occur and circumstances may require
adjustments to fees, schedules, locations,
or other aspects. The Rockford Park District
reserves the right to make such adjustments,
and apologizes for any inconveniences these
errors or adjustments may cause.
815-987-8800
23
online rockfordparkdistrict.org/TR
PLEASE COMPLETE BOTH SIDES OF THIS FORM, AND RETURN TO THE THERAPEUTIC RECREATION TEAM
Participant Name ___________________________________________________ Information collected from_____________________________________
Program(s) Registered For____________________________________________________________________________________________________
PARTICIPANT INFORMATION
Date of Birth________/______/________SexM
F
Primary Disability/Diagnosis___________________________________________________________________________________________________
Secondary Diagnosis________________________________________________________________________________________________________
Is the participant subject to seizures?
Yes
No
Date of last seizure_________ /_______/________
Describe seizure signs/symptoms, type, and frequency__________________________________________________________________________________
_____________________________________________________________________________________________________________________
Seizure Treatment_________________________________________________________________________________________________________
If Down Syndrome, has the participant been tested for Atlanto-Axial Instability?
Does your child have a shunt?
Yes
No
Yes
No
If yes, were the results positive?
Yes
No
Please describe_____________________________________________________________________
Does the participant have a specific diet, dietary restrictions, or any food that may cause behavioral changes? Yes
No
If yes, please explain________________________________________________________________________________________________________
Does the participant have any allergies?
Yes
No
If yes, please explain______________________________________________________________
Are there any side effects from medications that we should be aware of?
Yes
No
If yes, please explain______________________________________
REASONS FOR PARTICIPATING IN PROGRAM Please mark all that apply.
Physical Activity
Socialization/Friendships
Exposure
Motor Development
Group interaction
Creativity
Responsibility
Entertainment
Individual skill/development
FUN
Specific GOALS parents/guardians would like to see worked on_____________________________________________________________________________
_____________________________________________________________________________________________________________________
DAILY LIVING SKILLS
EATING
Can eat independently
Needs to be monitored
Needs physical assistance
Explain___________________________________
BATHROOM
Needs to be monitored
Needs physical assistance
Explain___________________________________
Can toilet independently
Detailed Comments_________________________________________________________________________________________________________
MOBILITY
Does the participant use any devices for mobility?
Mobility needs staff should be aware of
Manual wheelchair
Endurance
Motorized wheelchair
Balance
Crutches
Gait
Leg Braces
Other
Walker
Explain__________________________________________________________________________________________________________
COMMUNICATION
Verbal/speaks clearly
Uses hearing devices
Verbal/speech is difficult to understand
Has difficulty expressing needs
Uses a communication board/schedule/pictures
Other_________________ Gestures/points
Uses sign language
English as a second language (first language________________________ )
Detailed Comments_______________________________________________________________________
______________________________________________________________________________________________________________
INTERACTION/SOCIALIZATION SKILLS
Initiates social interaction on own
Socializes with verbal prompting
Avoids social interactions
Initiates socialization?
Explain__________________________________________________________________________________________________________
Prefers being
Alone
with peers
Is most successful in
Large groups
Responds better to
Males
with adults
Small groups
Females
Either
Explain_________________________________________________________________
Other
Explain___________________________________________________________
Explain_________________________________________________________________
Detailed Comments__________________________________________________________________________________________________
fax
815-987-8877
online
ANNUAL INFORMATION FORM
_____________________________________________________________________________________________________________________
24
815-987-8800
ABILITY TO FOLLOW DIRECTIONS
Independently
Can follow directions
With verbal prompting
With step-by-step assistance
fax 815-987-8877
Explain_______________________________
______________________________________________________________________________________________________________
BEHAVIORS/CONDUCT
Short attention span Easily distracted
Verbal outbursts
Hyperactivity
Physical outbursts towards others/self
Runs/wanders
Tantrums
Oppositional/defiant
Emotional meltdown
Manipulative
Shy/withdrawn
Steals
Instigates behavior
Other_____________________
Detailed Comments__________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
What are the known triggers?__________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
ANNUAL INFORMATION FORM
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Does the participant respond to specific behavior techniques (i.e., used at home or school)?
Yes
No Explain_________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Does the participant respond to specific reinforcement devices (i.e., used at home or school)?
Yes
No Explain_________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Does the participant display any unusual fears or concerns?
Yes
No Explain_____________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
PERSONAL INTERESTS
Favorite Quiet Activities__________________________________________ Favorite Active Games_____________________________________________
Favorite Colors_______________________ Other_________________________________________________________________________________
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name________________________________________ E-mail_________________________________________________________
Home Phone___________________________Cell Phone____________________________Work Phone_______________________________________
Emergency Contact______________________________________________________________ Phone_______________________________________
SCHOOL/WORK INFORMATION
School/Work_________________________________________________________ Grade_____ Teacher/Para________________________________
School/Work #________________________________________________ Classroom Setting______________________________________________
TRANSPORTATION
To program_______________________________________________ From program_____________________________________________________
STAFF/INDIVIDUAL COMPLETING FORM
DATE
25
online rockfordparkdistrict.org/TR
PARTICIPANT INFORMATION
HH ID#___________________
Last Name
First
Address
City
Home Phone
Birthdate
Parent/Guardian Name Work Phone
E-mail address (optional)
How did you find out about our program(s)?
billboard
e-newsletter
friend/relative
Does participant have allergies that may require medication (i.e., Epi Pen, Benadryl, etc.)?
Yes
StateZIP
/
Male
Age
Female
Cell Phone
magazine
Yes
/
newspaper
other
radio
TV
web site
No
If answering yes to either
medication question, please
request the Permission to
Administer Medication Form
from Customer Service
No
Does participant have a disability or medical condition that may require assistance or accommodation?
(i.e., diabetes, seizures, mental illness, conduct/behavior disorder, physical disability, developmental delay)
Yes
No
The Rockford Park District is committed to providing services in an equitable manner.
Answering the following is optional, but helps us measure how we are doing. RACE/ETHNICITY (select all that apply)
American Indian/Alaskan Native
Asian/Pacific Islander
Black
White
Hispanic (any race)
Other (please list)_______________________
EMERGENCY INFORMATION/AUTHORIZED PICK-UP
Please list any adult (age 18+) we should contact if the parent/guardian cannot be reached in the event of any emergency. Indicate anyone authorized to pick up your
child in the event that you are unable to do so. To ensure your children’s safety, they will not be released to any individual not named on this form. Adults must present a
photo ID at the time of pick-up.
Name
Phone #1
Phone #2
Relationship
May Pick Up
Name
Yes
No
Yes
No
Phone #1
Phone #2
Relationship
May Pick Up
PROGRAM INFORMATION
ID #
PROGRAM NAME
PROGRAM DATE
ADULT PROGRAMS ONLY:
IF PROVIDED, IS TRANSPORTATION
NEEDED? (add $4 to fee)
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
FEE
FORM CONTINUED ON THE NEXT PAGE • FORM IS NOT COMPLETE UNTIL BOTH SIDES HAVE BEEN FILLED IN
PARTICIPATION WILL BE DENIED if the signature of adult participant or parent/guardian and date are not on the waiver (see reverse side).
REGISTRATION
REGISTRATION
INFORMATION
FORM
Will participant need to take medication during program hours?
Middle
26
Participant’s Name (repeat from front)
FEE ASSISTANCE “Help Me Play” is available to residents for select youth programs. Call 815-987-8800 for more information.
PAYMENT INFORMATION
Would you like to donate to the Rockford Park District Fee Assistance program to aid kids who need financial help to participate in RPD programs?
Yes $________ No
Credit Card Number
Exp Date
TOTAL FEE
Signature (Authorization for Credit Card Use)
FOR YOUNG ADULT & BE SOCIAL PROGRAMS ONLY
REGISTRATION FORM
I LIVE IN A:
Group Home
Housing/Apartment Complex: Name__________________________________________________
Family Residence
Retirement/Nursing Home: Name____________________________________________________
WHERE SHOULD WE PICK YOU UP? (These are the only addresses that will be used for transportation routes)
At address listed on the front of this form
Meadow Mart, N Second St
Phillips 66, 4402 Linden Rd
Address of family or friend (list below)
Name Phone
Address
CityState
IMPORTANT INFORMATION
The Rockford Park District is committed to
conducting its recreation programs and activities in
a safe manner and holds the safety of participants
in high regard. The District continually strives to
reduce such risks and insists that all participants
follow safety rules and instructions that are
designed to protect the participants’ safety.
However, participants and parents/guardians of
minors registering for this program/activity must
recognize that there is an inherent risk of injury
when choosing to participate in recreational
activities/programs. You are solely responsible
for determining if you or your minor child/ward
are physically fit and/or adequately skilled for
the activities contemplated by this agreement.
It is always advisable, especially if the participant
is pregnant, disabled in any way or has recently
suffered an illness, injury or impairment, to
consult a physician before undertaking any
physical activity.
WARNING OF RISK
Recreational activities are intended to
challenge and engage the physical, mental
and emotional resources of each participant.
Despite careful and proper preparation,
instruction, medical advice, conditioning
and equipment, there is still a risk of serious
injury when participating in any recreational
activity. All hazards and dangers cannot
be foreseen. Depending on the particular
activity, certain risks, dangers and injuries
may exist due to inclement weather, slips
and falls, poor skill level or conditioning,
carelessness, horseplay, unsportsmanlike
conduct, premises defects, inadequate
or defective equipment, inadequate
supervision, instruction or officiating,
and other risks inherent to the particular
activity. In this regard, it is impossible for
the District to guarantee absolute safety.
Zip
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that in signing up and
participating in this program/activity, you will be expressly assuming the
risk and legal liability and waiving and releasing all claims for injuries,
damages or loss which you or your minor child/ward might sustain as
a result of participating in any and all activities connected with and
associated with this program/activity (including transportation services
and vehicle operations, when provided). I recognize and acknowledge
that there are certain risks of physical injury to participants in this
program/activity, and I voluntarily agree to assume the full risk of any
and all injuries, damages or loss, regardless of severity, that my minor
child/ward or I may sustain as a result of said participation. I further
agree to waive and relinquish all claims I or my minor child/ward may
have (or accrue to me or my child/ward) as a result of participating in this
program/activity against the Rockford Park District, including its officials,
agents, volunteers and employees (hereinafter collectively referred to
as “District”). I do hereby fully release and forever discharge the District
from any and all claims for injuries, damages, or loss that my minor
child/ward or I may have or which may accrue to me or my minor child/
ward and arising out of, connected with, or in any way associated with
this program/activity.
I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via
fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.
Participant’s Name (PLEASE PRINT) ______________________________________________________________________________
Parent/Guardian or Adult Participant Signature________________________________________________________________________
Date___________________
PARTICIPATION WILL BE DENIED if the signature of adult participant or parent/guardian and date are not on this waiver.
customer service
815-987-8800
27
helping others do what they do best
Collaboration & Community Partnerships
Through mutually beneficial partnerships, agencies can leverage resources to serve citizens that they
could not serve alone. The Rockford Park District celebrates the following agencies and businesses that
work together with the Therapeutic Recreation Team to “Help People Enjoy Life.”
RAMP — Winnebago County branch
www.rampcil.org • 815-968-7467
Barbara Olson Center of Hope
www.b-olsoncenterofhope.org • 815-964-9275
Rockford Art Museum
www.rockfordartmuseum.org • 815-968-2787
Belvidere Park District
www.belviderepark.org • 815-547-5711
Rockford Chariots Wheelchair
Athletic Association
Facebook.com/RockfordChariots
Center for Sight and Hearing
www.rockfordcenter.org • 815-332-6800
Child and Family Connections
www.accessni.com • 815-654-6170
Division of Specialized Care for Children
www.uic.edu/hsc/dscc • 815-987-7571
Easter Seals —Metropolitan Chicago
www.chicago.easterseals.com • 815 965-6745
Freeport Park District
www.freeportparkdistrict.org • 815-235-6114
Gigi’s Playhouse
www.gigisplayhouse.org • 847-885-PLAY
Harlem School District
www.harlem122.org • 815-654-4500
National Inclusion Project
www.nationalinclusionproject.org
Northwestern Illinois Association
www.thenia.org • 815-895-9227
fax
815-987-8877
online
Rockford Dance Company
www.rockforddancecompany.com
815-963-3341
Rockford Public Schools
www.rps205.com • 815-966-3000
Rosecrance Ware Center
www.rosecrance.org • 815-968-9300
Special Olympics
www.specialolympics.org
The Arc
www.arcwbo.org • 815-965-3455
The Autism Program Service Center of
Rockford
www.theautismprogram.org • 815-395-5566
YMCA of the Rock River Valley
www.rockfordymca.org • 815-987-2252
COMMUNITY RESOURCES
Access Services of Northern Illinois
www.accessni.com • 815-282-8824
ROCKFORD PARK DISTRICT
PRSRT STD
U.S. POSTAGE
PAID
Rockford, IL
Permit #4585
401 S MAIN ST • ROCKFORD IL 61101
www.rockfordparkdistrict.org
BOARD OF COMMISSIONERS
Jack L. Armstrong • Douglas J. Brooks • Julie Elliott
Ian K. Linnabary • Tyler Smith
EXECUTIVE DIRECTOR Tim Dimke
WINTER / SPRING
2016 GUIDE
FREE! Easter Seals Family Fun Night
FREE
EVENTs!
Friday, April 8; 6:00–9:00 pm
presented by
Carlson Ice Arena and Sapora Playworld, 4150 N Perryville Rd, Loves Park
Celebrate Autism Awareness Month by coming out to play at the Annual Family
Fun Night for families with children with a developmental disability. We’ll dine,
skate, and play at Carlson Ice Arena with the assistance of the Rockford Park
District’s Therapeutic Recreation staff.
Registration is required and opens March 21; registration is limited to the
first 150 people. ALL reservations must be made by calling Patti Mook, Easter
Seals Metropolitan Chicago-Rockford Region, at 815-965-5069; your reservation
is not confirmed until you have spoken with her.
FREE! Mornings of Fun for Everyone
the following Saturdays in 2016: April 2, June 4, and Aug 6, Oct 1;
9:00–10:00 am
The schedule for the evening is as follows:
Discovery Center Museum, 711 N Main St, Rockford, IL
6:00–6:30 pm: Check in
We invite children with disabilities and their immediate families to experience
Discovery Center Museum’s multi-sensory exhibits and activities free of charge before
the museum opens to the general public. A healthy snack will be served at 10:00
am, and families are welcome to stay and play after the museum opens to the public
that day. Advance registration is required to receive free admission. Call Sue
Stevens at 815-972-2839 or e-mail [email protected].
6:30–7:30 pm: Dinner
7:00–8:00 pm: Playtime in Sapora Playworld
8:00–9:00 pm: Ice Skating
CUSTOMER SERVICE • SE HABLA ESPAÑOL
815-987-8800 • rockfordparkdistrict.org/TR
REGISTRATION
OPENS JAN 11

registration opens jan 11

Transcription

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