Lily Cache Special Recreation Association
2 017 w i n t e r / s p r i n g G u i d e lilycachesra.org
Registration B e g i n s Registration december RESIDENT: B e g i n7 s NON-RESIDENT : 21
D E C E M B E R RESIDENT: NON-RESIDENT :
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D i s c o v e r Recreational Programs and Opportunities for People With Disabilities 1
Serving Bolingbrook and Plainfield Park Districts 201 Recreation Drive, Bolingbrook P 630.739.1124 Relay 800.526.0844 lilycachesra.org Lily Cache Special Recreation Association is a cooperative extension of the Bolingbrook Park District and Plainfield Park District that provides year-round recreation programs for individuals with disabilities.
LC SRA S ta ff
R e g is t r a t i o n b e g i n s L csra resident: non - resident:
D ecember 7 december 2 1
Faci l i t y Di r ec tory Lily Cache Special Recreation Assocation (LCSRA) 201 Recreation Drive, Bolingbrook P (630) 739-1124Â | Relay (800) 526-0844
Jill Mukushina, Superintendent of Special Recreation jmukushina@lilycachesra.org | 630.783.6583
ACC: Annerino Community Center 201 Recreation Drive, Bolingbrook
Sherrie Izban, Therapeutic Recreation Supervisor sizban@lilycachesra.org | 630.783.6584
BRAC: Bolingbrook Recreation & Aquatic Complex 200 S. Lindsey Lane, Bolingbrook
Carrie Gascoigne, Therapeutic Recreation Supervisor cgascoigne@lilycachesra.org | 630.783.6585
HPC: Heritage Professional Center 24023 West Lockport Street, Plainfield
Gina Petkus, Therapeutic Recreation Supervisor gpetkus@lilycachesra.org | 630.783.6581
OAKS: Hidden Oaks Nature Center 475 Trout Farm Road, Bolingbrook
LC SRA A dv iso ry Boa r d
Mike Baiardo, Director of Recreation & Facilities Bolingbrook Park District
PREC: Plainfield Recreation/Administration Center, 23729 W. Ottawa Street, Plainfield TS:
The Streams 24319 Cedar Creek Lane, Plainfield
Carlo Capalbo, Executive Director Plainfield Park District
I n de x
Cheryl Crisman, Director of Recreation Plainfield Park District
Who We Are
3
Behavior/Code of Conduct & Wellness Guidelines
6
Month at a Glance
7-11
Programs
12-25
Code of Conduct Form
26
Medication Dispensing Permission & Form
27
Medication Dispensing Information
28
Annual Information Form
29-30
Special Olympics Form
31-32
Registration Form/Information
33-34
More about LCSRA
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Ron Oestreich, Executive Director Bolingbrook Park District Kim Smith, Director of Marketing and Customer Care Bolingbrook Park District Corinne Vargas, Senior Designer/Graphic Artist Plainfield Park District
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Meet stacie
W ho W e A r e
Lily Cache Special Recreation Association (LCSRA) represents the partnership between Bolingbrook and Plainfield Park Districts in their mission to serve the special needs population. Our goal is to provide recreational programs which build self-esteem and promote a lifetime of growth. LCSRA strives to go beyond the normal range of services and programs offered by schools or other agencies. Lily Cache Special Recreation Association fosters an environment which allows individuals to discover their own unique potential and abilities. LCSRA serves individuals with disabilities which can include but are not limited to physical disabilities, developmental disabilities, communication disorders, emotional/behavior disorders, and autism spectrum disorder.
Hi! My name is Stacie Ritz. I graduated from Eastern Illinois University with a bachelor degree in Recreation Administration and concentration in Therapeutic Recreation. Prior to coming to the LCSRA Cruisers program, I worked for SEASPAR in Downers Grove. For eight years I coordinated the Teen and Adult social clubs, special events and also was the inclusion coordinator. My next adventure was running an in home day care for nine years. Now that all the kids are in full time school, I came back to my roots. Running programs is what I love most in the field of Special Rec, so the Cruisers Bulldogs is a perfect fit for me!
Participants and Programs Our programs are as diverse and engaging as the participants they serve. From social events, seasonal camps and imaginative trips to competitive Special Olympic sports, LCSRA programs offer many benefits, including: • Improved self-confidence and self-esteem • Greater independence • Social interaction and relationship-building • Reinforce existing skills • Opportunities to explore new skills/talents • Build friendships and sense of community • Memories for life
Like LCSRA on Facebook for more program information, great photos and to share feedback with us.
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Special Olympics Illinois and LCSRA are hosting a fundraiser, with proceeds benefiting both Special Olympics and LCSRA through a Revenue Sharing Raffle. For just $5 per ticket, your money will benefit two great organizations, while giving yourself a chance to win! Through two years of the fundraiser, Special Olympics Illinois was able to raise nearly $15,000 for agencies participating!
Tickets: $5 First Prize: $300 Second Prize: $150 Third Prize: $50 Raffle begins January 6. Raffle will be drawn May 6 at the 2017 Spring Games. Winner need not be present to win.
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behavior/code of conduct & wellness guidelines To ensure that all LCSRA participants enjoy programs and events to their fullest, and in the interest of safety, we use the following guidelines : Behavior/Code of Conduct LCSRA will attempt reasonable accommodations to enable participants to meet behavior expectations. • Show respect to all participants, staff, and public. • Listen to and comply with staff direction and program rules. • Allow others in the program and others at public facilities to enjoy the activity without disruption (within reason). • Refrain from using foul language, discussing inappropriate topics or other offensive behavior. • Refrain from threatening or causing bodily harm or offensive physical contact to self, other participants, staff or public. • Show respect to equipment, supplies, and facilities. Additional rules are developed for specific programs as deemed necessary by the staff. If inappropriate behaviors occur, a prompt resolution will be sought specific to each individual. LCSRA reserves the right to dismiss participants whose behavior endangers the safety of themselves or others. Wellness Guidelines In consideration of other participants and staff, and to prevent the spread of contagious illnesses, it is recommended that participants refrain for programs when any of the following conditions exist: • Fever of 100° or higher • Vomiting within the last 24 hours • Persistent diarrhea in conjunction with other symptoms • Contagious rash or a rash of unknown origin • Persistent cough and/or cold symptoms • Eye infections or discharge from the eye • Symptoms of mumps, measles, chicken pox, strep throat, flu, impetigo, or Coxsackie’s virus • Runny nose with yellow or green discharge • Lice or mites • Fatigue due to illness that hinders participation in a program Please notify LCSRA if the participant contracts any contagious illness that will affect their attendance at a program. Participants should return to programs at the doctor’s recommendation, or, if not under a doctor’s care, when the symptoms have clearly passed. LCSRA reserve the right to dismiss participants who show signs of illness.
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Calendar at a glance ja n ua ry Sunday 1
Monday 2 No Cruisers
Tuesday 3 LCSRA Basketball NO Cruisers
Wednesday 4 NO Cruisers
Thursday 5
Friday 6
Saturday 7 Junior Basketball
8 Teen Book Club
9 Swim Team Board Game Bonanza Swim Lessons
10 LCSRA Basketball Individual Ukulele Group Ukulele
11 Gymnastics Kids in the Kitchen
12 Rhythmic Gymnastics
13 Social Club Glow with the Flow Dance
14 Junior Basketball Legoland Trip Dinner & Movie B
15
16 NO SWIM TEAM NO SWIM LESSONS Board Game Bonanza
17 LCSRA Basketball Individual Ukulele Group Ukulele
18 Gymnastics Kids in the Kitchen Fitness
19 SO Bowling League Rhythmic Gymnastics Bowling
20
21 Junior Basketball
22 Sunday Funday
23 Swim Team Board Game Bonanza Swim Lessons
24 LCSRA Basketball Individual Ukulele Group Ukulele
25 Gymnastics Kids in the Kitchen Fitness
26 SO Bowling League Rhythmic Gymnastics Bowling
27
28 Junior Basketball Dinner & Movie A
29
30 Swim Team Board Game Bonanza Swim Lessons
31 LCSRA Basketball Bocce Individual Ukulele Group Ukulele
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fe b rua ry Sunday
Monday
Tuesday
Wednesday 1 Gymnastics Kids in the Kitchen Fitness
Thursday 2 SO Bowling League Rhythmic Gymnastics Lil’ Senses Bowling
Friday 3 Friday Friends
Saturday 4 Junior Basketball Sensory Art Lunch Bunch HangTime Dinner & Movie B
5 Teen Book Club
6 Swim Team Swim Lessons
7 LCSRA Basketball Bocce State Winter Games Individual Ukulele Group Ukulele
8 Gymnastics State Winter Games Kids in the Kitchen Fitness
9 SO Bowling League Rhythmic Gymnastics Powerlifting State Winter Games Lil’ Senses Bowling
10 Social Club Valentine’s Dance Friday Friends
11 Junior Basketball SO Area Swim Meet Sensory Art Lunch Bunch HangTime
12 Sunday Funday
13 Swim Team Equestrian Swim Lessons
14 LCSRA Basketball Bocce
15 Gymnastics Kids in the Kitchen Fitness
16 SO Bowling League Rhythmic Gymnastics Powerlifting Lil’ Senses DuPage Children’s Museum Outing Bowling
17 Friday Friends
18 ITRS Junior Basketball Tournament Sensory Art Lunch Bunch HangTime
19 ITRS Basketball Tournament
20 NO SWIM TEAM NO SWIM LESSONS Track & Field Equestrian Partner’s Club
21 Bocce Individual Ukulele Group Ukulele Musical Theatre Name That Tune
22 Gymnastics Fitness
23 SO Bowling League Rhythmic Gymnastics Powerlifting Lil’ Senses Bowling
24 Mardi Gras Mambo Friday Friends Dinner & Movie A
25 Sensory Art Lunch Bunch HangTime
26 Blackhawks Game
27 Swim Team Track & Field Equestrian Swim Lessons
28 Bocce Individual Ukulele Group Ukulele Musical Theatre Name That Tune
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m a rc h Sunday
Monday
Tuesday
Wednesday 1 Gymnastics Soccer Team Fitness
Thursday 2 SO Bowling League Rhythmic Gymnastics Powerlifting Lil’ Senses Bowling
Friday 3 Social Club Shamrock Shuffle Dance Friday Friends
Saturday 4 SO District Swim Meet Chords for Kids Maple Tapping
5 Teen Book Club
6 NO SWIM TEAM NO SWIM LESSONS Track & Field Equestrian
7 Bocce Individual Ukulele Group Ukulele Musical Theatre Name That Tune
8 Gymnastics Soccer Team Sensory Stimulation
9 Rhythmic Gymnastics Powerlifting Lil’ Senses
10 Friday Friends
11 Musical Melodies Lunch Bunch HangTime Dinner & Movie B
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13 Swim Team Track & Field Equestrian
14 Bocce Individual Ukulele Group Ukulele Musical Theatre Name That Tune
15 Gymnastics Soccer Team Sensory Stimulation Aquacise
16 Rhythmic Gymnastics Powerlifting
17 SO STATE BASKETBALL
18 SO STATE BASKETBALL Musical Melodies Lunch Bunch HangTime
19 SO STATE BASKETBALL
20 Swim Team Track & Field Equestrian Partner’s Club Swim Lessons
21 Bocce Batting Practice Individual Ukulele Group Ukulele Musical Theatre Name That Tune
22 Gymnastics Soccer Team Sensory Stimulation Aquacise
23 SO Bowling League Rhythmic Gymnastics Powerlifting Bowling
24 Celebrity LookA-Likes Dance
25 Musical Melodies Lunch Bunch HangTime Dinner & Movie
26 Sunday Funday
27 Swim Team Track & Field Spring Break Camp Swim Lessons
28 Bocce Batting Practice Musical Theatre Name That Tune Spring Break Camp
29 Gymnastics Soccer Team Spring Break Camp Sensory Stimulation Aquacise
30 SO Bowling League Rhythmic Gymnastics Powerlifting Spring Break Camp Bowling
31 Friday Friends Spring Break Camp
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A pr i l Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday 1 Musical Melodies Lunch Bunch HangTime Geocaching Dinner & Movie B
2 April Pools Day Light It Up Blue
3 Swim Team Track & Field Equestrian Swim Lessons
4 Bocce Batting Practice Individual Ukulele Group Ukulele Musical Theatre Name That Tune
5 Soccer Team Sensory Stimulation Aquacise
6 SO Bowling League Powerlifting Bowling
7 Mexican Fiesta Friday Friends
8 SO Area Bocce Tournament Musical Melodies Lunch Bunch HangTime Geocaching
9 Teen Book Club
10 NO SWIM TEAM NO SWIM LESSONS Track & Field Equestrian Spring Break Camp NO Cruisers
11 Batting Practice Individual Ukulele Group Ukulele Musical Theatre Name That Tune Spring Break Camp NO Cruisers
12 Soccer Team Sensory Stimulation Spring Break Camp NO Cruisers
13 SO Bowling League Powerlifting Spring Break Camp NO Cruisers
14 NO Cruisers
15
16
17 Swim Team Track & Field Equestrian Partner’s Club Swim Lessons
18 Softball Team Individual Ukulele Group Ukulele Musical Theatre Name That Tune
19 Tennis Soccer Team Sensory Stimulation Let’s Make a Difference Aquacise
20 SO Bowling League Powerlifting Bowling
21 SocialClub Friday Friends
22 Amazing Animals Lunch Bunch HangTime Geocaching Dinner & Movie A Day Camp Registration
23 Sunday Funday
24 Swim Team Track & Field Equestrian Swim Lessons
25 Softball Team Individual Ukulele Group Ukulele Musical Theatre Name That Tune
26 Tennis Soccer Team Sensory Stimulation Let’s Make a Difference Aquacise
27 SO Bowling League Powerlifting Bowling
28 Friday Friends
29 Amazing Animals Lunch Bunch HangTime Geocaching
30 SO Powerlifting Qualifier
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m ay Sunday
Monday 1 Swim Team Track & Field Equestrian Swim Lessons
Tuesday 2 Softball Team Individual Ukulele Group Ukulele Musical Theatre Name That Tune
Wednesday 3 Tennis Soccer Team Spring Golf Club Let’s Make a Difference Aquacise
Thursday 4 SO Bowling League Bowling
Friday 5 Friday Friends
Saturday 6 SO Area Spring Games Amazing Animals Lunch Bunch HangTime Geocaching Dinner & Movie B
7 SO Soccer Qualifier Teen Book Club
8 Equestrian
9 Softball Team Musical Theatre Name That Tune
10 Tennis Soccer Team Spring Golf Club Let’s Make a Difference
11 SO Bowling League Bowling
12 Social Club Spring Formal Dance Friday Friends
13 Amazing Animals Lunch Bunch HangTime Geocaching Dinner & Movie A
14
15 Partner’s Club
16 Softball Team
17 Tennis Soccer Team Spring Golf Club Let’s Make a Difference
18
19
20 Saturday Night Fever Autism Walk
21 ITRS Soccer Tournament Sunday Funday
22
23 Softball Team
24 Tennis Spring Golf Club
25
26
27
28
29 NO Cruisers
30 Softball Team NO Crusiers
31 Tennis Spring Golf Club
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Progr a ms Aktion Club LCSRA has partnered up with the Kiwanis to offer Aktion Club to our participants. This is a service leadership program for adults with disabilities. Aktion Club Plainfield meets at 6:30 pm on the first Thursday of every month at the Plainfield United Methodist Church. If you are interested in learning more, contact Jill Mukushina at (630) 7836583 or jmukushina@lilycachesra.org. Aktion Club Bolingbrook meets at 3:15 pm on the first Tuesday of every month at the Annerino Community Center. If you are interested in learning more, contact Carrie Gascoigne at (630) 783-6585 or cgascoigne@lilycachesra.org. Community Cruisers Community Cruisers is a recreation based program developed to meet the needs of young adults with disabilities that are no longer eligible for school services. The program provides opportunities for individuals to reach their full potential through recreational activities that promote positive peer interactions, community integration, and some basic life skills. All interested participants need to complete paperwork which includes an intake assessment to evaluate which of our programs is most appropriate for each individual. If you are interested in the program please contact Carrie Gascoigne at (630) 783-6585 or cgascoigne@lilycachesra.org for further information.
W eek ly Progr a ms Swim Lessons Ages 3 years & Up Dive right in to fun while learning swim skills, strengthening muscles and increasing coordinating. Lessons are taught in small groups or one on one ratio and are conducted at the Pelican Harbor Indoor Pool. Dates
Jan 9-Feb 27 Jan 9-Feb 27 Jan 9-Feb 27 Jan 9-Feb 27 Mar 20-May 1 Mar 20-May 1 Mar 20-May 1 Mar 20-May 1
Time
5:00-5:30 pm 5:30-6:00 pm 6:00-6:30 pm 6:30-7:00 pm 5:00-5:30 pm 5:30-6:00 pm 6:00-6:30 pm 6:30-7:00 pm
Code
15400A 15400B 15400C 15400D 15400E 15400F 15400G 15400H
Day: Monday Location: Pelican Harbor Indoor Aquatic Park LCSRA Resident Fee: $78 LCSRA Non-Resident Fee: $98 No Class: January 16, February 20, April 10 Key Contact: Gina Petkus
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Deadline Jan 4 Jan 4 Jan 4 Jan 4 Mar 13 Mar 13 Mar 13 Mar 13
Board Game Bonanza Ages 10-17 years Nothing brings family and friends together like a good board game. Every week a new game will be introduced and some old favorites will make their appearance as well. This will be a light hearted environment with friends. Snacks will be provided. Day: Monday Date: January 9-30 Time: 6:00-8:00 pm Location: Annerino Community Center LCSRA Resident Fee: $19 15115A LCSRA Non-Resident Fee: $24 Deadline: January 1 Key Contact: Gina Petkus Partners Club Ages 6-17 years Everyone has unique talents and abilities. Let’s bring both children with disabilities and children without disabilities all in one group to enjoy a night of fun recreational activities. We will learn about people’s differences and how best to support each other. This is a perfect class for siblings are close friends to do together. Day: Monday Date: February 20, March 20, April 17, May 15 Time: 7:00-8:30 pm Location: Annerino Community Center LCSRA Resident Fee: $24 15453A LCSRA Non-Resident Fee: $30 Deadline: February 6 Key Contact: Gina Petkus Individual Ukulele Lessons Ages 6-21 years The Ukulele is a stringed instrument that originated in Hawaii as a version of the Portuguese machete. Later it spread throughout the United States. The ukulele is a great starter instrument for children because of its size and portability. Skills learned here can easily be transferred to other instruments as your child improves. Cost of the class will include instruction by a music therapist. If this is your first time in the class, a ukulele will also be provided. Date
Ages
Deadline
Code
LCSRA Res Fee
Jan10-Feb 7 Jan 10-Feb 7 Feb 21-Mar 21 Feb 21-Mar 21 Apr 4-May 2 Apr 4-May 2
6-17 18-21 6-17 18-21 6-17 18-21
Jan 1 Jan 1 Feb 7 Feb 7 Mar 21 Mar 21
15116A 15116B 15116C 15116D 25116A 25116B
$150 $150 $150 $150 $150 $150
Day: Tuesday Time: 4:30-5:00 pm Location: Annerino Community Center Key Contact: Gina Petkus
LCSRA NonRes Fee
$188 $188 $188 $188 $188 $188
Year-round programs for individuals with disabilities
Group Ukulele Lessons Ages 6-21 years The Ukulele is a stringed instrument that originated in Hawaii as a version of the Portuguese machete. Later it spread throughout the United States. The ukulele is a great starter instrument for children because of its size and portability. Skills learned here can easily be transferred to other instruments as your child improves. Cost of the class will include instruction by a music therapist. If this is your first time in the class, a ukulele will also be provided. Classes are held in small groups, no more than 3 participants per session. Date
Ages
Deadline
Codes
LCSRA Res Fee
LCSRA Non-Res Fee
Jan 10-Feb 7 Jan 10-Feb 7 Feb 21-Mar 21 Feb 21-Mar 21 April 4-May 2 April 4-May 2
6-17 18-21 6-17 18-21 6-17 18-21
Jan 1 Jan 1 Feb 7 Feb 7 Mar 21 Mar 21
15117A 15117B 15117C 15117D 25117A 25117B
$69 $69 $69 $69 $69 $69
$87 $87 $87 $87 $87 $87
Day: Tuesday Time: 5:00-5:30 pm Location: Annerino Community Center Key Contact: Gina Petkus
Name That Tune Ages 8-21 years Let’s sing our heart out! Together we will learn a wide variety of songs that you hear on the radio. Basic voice skills such as melody, harmony and cadence will be taught in a group atmosphere. This class will be taught by a music therapist. On May 9th the group will perform during the intermission of the Musical Theatre performance. Ages
8-17 years 18-21 years
Codes
15113A 15113B
Day: Tuesday Date: February 21-May 9 Time: 5:30-6:30 pm Location: Annerino Community Center LCSRA Resident Fee: $84 LCSRA Non-Resident Fee: $105 Deadline: February 7 Key Contact: Gina Petkus
Musical Theatre Ages 8-21 years Musical Theatre is a form of artistic expression and can be celebrated by all individuals. Over the course of 12 weeks, we will let our creative juices flow as we prepare to entertain family and friends in a small performance. The session would incorporate movement, improvisation, singing and acting and culminate with a final group performance on May 9th! Weather you prefer a small part or a large one, a singing part or a dancing part, come and join us for this new experience. This class will be led by a music therapist who will assist us in connecting through music as we prepare for the show. Ages
8-17 years 18-21 years
Codes
15450A 15450B
Day: Tuesday Date: February 21-May 9 Time: 6:30-7:30 pm Location: Annerino Community Center LCSRA Resident Fee: $169 LCSRA Non-Resident Fee: $211 Deadline: February 7 Key Contact: Gina Petkus
Kids in the Kitchen Ages 6-17 years Food always tastes better when you share it with others! In this hands on class, we will be making a main course and dessert or appetizer for each class. Pictorial recipes will be provided for all participants to follow and create a scrumptious meal. After working hard in the kitchen, we will sit back with our friends and enjoy the fruits of our labor. Day: Wednesday Date: January 11-February 15 Time: 4:30-6:30 pm Location: HPC LCSRA Resident Fee: $66 15111A LCSRA Non-Resident Fee: $83 Deadline: January 1 Key Contact: Gina Petkus
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LCSRA Fitness Classes It is important to keep up a regular fitness program so as to maintain your weight and health. Physical activity can help keep you strong, happy, and healthy. LCSRA fitness classes can help motivate you to stay physically active and in shape. Toning & Strength will provide low impact exercises that participants can do at their own level. The class will be using light weights and bands. Aquacise will be at Pelican Harbor in the indoor pool focusing on a variety of exercises in the water that will help to tone and strengthen the entire body. Class
Toning & Strength Toning & Strength Aquacise Aquacise
Ages
Date
Code
Deadline
Location
10-17
Jan 18-Mar 1
15403A
Jan 9
ACC
18 & up
Jan 18-Mar 1
15403B
Jan 9
ACC
10-17 18 & up
Mar 15-May 3 Mar 15-May 3
15403C 15403D
Mar 6 Mar 6
BRAC BRAC
Day: Wednesday Time: 6:15-7:00 pm LCSRA Resident Fee: $84 LCSRA Non-Resident Fee: $103 No Class: April 12 Key Contact: Carrie Gascoigne
Sensory Stimulation Ages 6-17 years This program is specifically designed for youth who are physically challenged and have multiple needs. Come and entertain your senses with a variety of stimuli. Activities will include visual, olfactory, auditory, oral and tactile stimulation to create a multisensory experience. A variety of positioning and simple stretching will be used in this one hour class. Day: Wednesday Date: March 8-April 26 Time: 6:30-7:30 pm Location: Annerino Community Center LCSRA Resident Fee: $79 15118A LCSRA Non-Resident Fee: $99 Deadline: February 22 Key Contact: Gina Petkus Let’s Make a Difference Ages 8-17 years Let’s make a difference in the world around us! We will be giving back to our community and the world. Both in house activities and field trips will be provided. We will also discuss how we can think of others on a daily/weekly basis. A schedule with the details will be sent out a week prior to the first trip. Day: Wednesday Date: April 19-May 17 Time: Evening Location: Varies LCSRA Resident Fee: $49 25115A LCSRA Non-Resident Fee: $61 Deadline: April 5 Transportation: Provided from ACC and PREC Key Contact: Gina Petkus
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Bowling League Join your friends for a fun, relaxing hour of socializing while participating in this non-competitive sport. Staff will provide basic instruction for beginner bowlers, while working with the return bowlers on different strategies to improve their game. Scores will be recorded each week. Bumpers and ramps are available as needed. The cost includes use of the lanes, shoes, and two games of bowling. Ages
5-17 18 & up 5-17 18 & up
Date
Jan 19-Mar 2 Jan 19-Mar 2 Mar 23-May 11 Mar 23-May 11
Code
15410A 15410D 25410A 25410D
Day: Thursday Time: 4:00-5:00 pm Location: Brunswick Zone, Romeoville LCSRA Resident Fee: $60 LCSRA Non-Resident Fee: $81 Key Contact: Sherrie Izban
Deadline Jan 9 Jan 9 Mar 13 Mar 13
Lil’ Senses Ages 2-6 years with parent Children learn best by real life experiences. They take in the world around them through their senses and form opinion based on these experiences. In Lil’ Senses we will discover a theme a week and fully explore it with all five senses through hands on activities. Please wear comfortable loose fitting clothes that are ok to get messy. Day: Thursday Date: February 2-March 9 Time: 10:30-11:15 am Location: Annerino Community Center LCSRA Resident Fee: $45 15114A LCSRA Non-Resident Fee: $57 Deadline: January 19 Key Contact: Gina Petkus
Year-round programs for individuals with disabilities
Social Club Ages 21 years & up Friday nights are great for visiting with old friends and making some new ones. Enjoy activities and social opportunities locally and in neighboring communities. Program times may vary depending on scheduled events. A schedule with complete details will be provided the week prior to the first meeting date. You don’t want to miss an exciting evening of this Friday fun club. Date
Event
Jan 13 Feb 10 Mar 3 Apr 21 May 12
Glow with the Flow Valentine’s Dance Shamrock Shuffle Picasso Party Spring Formal
Day: Friday Time: Varies Location: Varies LCSRA Resident Fee: $202 15102A LCSRA Non-Resident Fee: $253 Deadline: January 3 Transportation: Provided from Plainfield and Annerino Key Contact: Sherrie Izban Friday Friends Ages 8-17 years Does your child have trouble making and maintaining friends? Do they have a difficult time relating to their peers? Do they struggle with understanding the perceptions of others? Then this is a group for your child. The focus of this group will be how to develop social skills and then how to implement them in recreational activities. Participants must be able to role play scenarios, discuss feelings and use symbolic thinking. This group will primarily meet in house but will also attend events in the community so that participants can apply what they have learned in “real life” scenarios. Participants will be grouped by age and ability. LCSRA reserves the right to determine if this program is appropriate for an individual. Date
Feb 3-Mar 10 Mar 31-May 12
Deadline Jan 20 Feb 7
Day: Friday Time: 6:00-8:30 pm Location: Annerino Community Center LCSRA Resident Fee: $84 LCSRA Non-Resident Fee: $105 Transportation ACC: Pick-up 6:00 pm/Drop-off 8:30 pm PREC: Pick-up 5:30 pm/Drop-off 9:00 pm Key Contact: Gina Petkus
Codes
15412A 25443A
Dinner and Movie Enjoy a meal and the new 2017 releases. The movie choice, restaurant, along with times for each program will be communicated to participants no later than 2:00 pm on the Friday prior to the program. Fee includes movie admission, staff supervision, and transportation. Participants are responsible for the cost of their dinner, including tip and any concession snacks at the theater. Age
Rating
8-17
G or PG
18 & up
PG or PG13
Dates
Jan 28, Feb 25, Mar 25, Apr 22, May 13 Jan 14, Feb 4, Mar 11, Apr 1, May 6
Code 15408A 15408B
Day: Saturday Time: Varies Location: Various restaurants and movie theaters in the community. LCSRA Resident Fee: $130 LCSRA Non-Resident Fee: $153 Deadline: January 2 Transportation: Provided from ACC and PREC Key Contact: Carrie Gascoigne Geocaching Ages 12-17 years There are millions of geocaches around the world, but it takes a special detective team to find them. Participants will plant their own geocaches and then post their geocaches for others to find. Then, they will search for geocaches planted by others. Every week the team will explore a different city including: Bolingbrook, Plainfield, Romeoville, Naperville, Woodridge, Joliet/Shorewood. Day: Saturday Date: April 1-May 13 Time: 9:00-11:30 am Location: Varies LCSRA Resident Fee: $55 25118A LCSRA Non-Resident Fee: $69 Deadline: March 18 Transportation ACC: Pick-up 8:00 pm/Drop-off 1:00 pm PREC: Pick-up 8:30 pm/Drop-off 12:30 pm Key Contact: Gina Petkus
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Speci a l E v en t s Teen Book Club Ages 13-21 years Grab a book and get to know some friends over brunch. Participants will read the selected book or have the book read to them prior to the assigned meeting date. On the meeting date, friends will come together to discuss the book over a delicious meal. Please be prepared to answer questions and fully participate in the discussion. Book selections will be chosen by the participants each month. Ages
13-17 18-21
Codes
15421A 15421B
Day: Sunday Date: January 8, February 5, March 5, April 9, May 7 Time: 11:00 am-12:30 pm Location: Varies LCSRA Resident Fee: $54 LCSRA Non-Resident Fee: $68 Deadline: February 7 Transportation ACC: Pick-up 10:00 am/Drop-off 1:30 pm PREC: Pick-up 10:30 am/Drop-off 1:00 pm Key Contact: Gina Petkus Sunday Funday Ages 8-17 years Are you ready for some fun? Let’s hang out with our friends and enjoy a variety of recreational experiences. This season we will be celebrating the fall holidays with our friends. A schedule with the details will be sent out a week prior to the first trip. Day: Sunday Date: January 22, February 12, March 26, April 23, May 21 Time: Afternoon to Early Evening Location: Varies LCSRA Resident Fee: $129 15112A LCSRA Non-Resident Fee: $162 Deadline: January 8 Transportation: Provided from ACC and PREC Key Contact: Gina Petkus
Glow with the Flow Ages 13 years & up Tonight we will glow in the dark and dance the night after enjoying a pizza dinner and receive our party favor. This dance is included in the social club schedule. Ages
13-17 18 & up
Codes
15445A 15445B
Day: Friday Date: January 13 Time: 6:30-9:00 pm Location: LWSRA Building, New Lenox Fee: $25 Deadline: December 28 Transportation PREC: Pick- up 5:30 pm /Drop-off 9:45 pm ACC: Pick-up 6:00 pm /Drop-off 10:15 pm Key Contact: Sherrie Izban Legoland Ages 8-17 years Join your friends, get out of the cold and spend the day exploring one of kind LEGO creations. You will see LEGOS displayed in ways you have never seen before. Exhibits include life size models, 4D movies, rides and so much more. Bring out the inner engineer in you today! Day: Saturday Date: January 14 Time: 10:30 am-2:00 pm Location: Legoland, Schaumburg LCSRA Resident Fee: $59 15201A Deadline: January 1 Transportation ACC: Pick-up 9:00 am/Drop-off 3:00 pm PREC: Pick-up 9:30 am/Drop-off 3:30 pm Key Contact: Gina Petkus Valentine Dance Ages 13 years & up Share the love at the annual Valentine dance. The evening will include a DJ, dinner and prizes. This dance is included in the social club schedule. Ages
13-17 18 & up
Codes
15302A 15302B
Day: Friday Date: February 10 Time: 7:00 pm -9:30 pm Location: Joliet Park District Multi-Purpose Center Fee: $25 Deadline January 20 Transportation ACC: Pick-up 6:00 pm / Drop-off 10:30 pm PREC: Pick- up 6:30 pm /Drop-off at 10:00 pm Key Contact: Sherrie Izban
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Year-round programs for individuals with disabilities
Mardi Gras Mambo Ages 13 years & up Mambo the night away with friends! Enjoy music from a DJ, dancing and snacks at the dance. Ages
13-17 18 & up
Codes
15420A 15420B
Day: Friday Date: February 24 Time: 7:00-9:00 pm Location: Oak Lawn Park District Pavilion Fee: $ 19 Deadline: February 10 Transportation: PREC: Pick- up 5:30 pm /Drop-off 9:45 pm ACC: Pick-up 6:00 pm/ Drop-off 10:15 pm Key Contact: Sherrie Izban Chicago Blackhawks Game Ages 18 years & up This year promises to be exciting for the Blackhawks. Why not join in on the excitement? Hockey is a game of strength, agility and speed, and in the NHL the action never stops. Come watch as the Blackhawks take on their Division rivalries the St. Louis Blues. Bring at least $20 for concessions and extra money for souvenirs. Staff will call parents or guardians before leaving the United Center with pick up times. PLEASE NOTE: our seats are in Section 307 … in Rows 3, 4 and 5. Day: Sunday Date: February 26 Time: 6:30 pm puck drops Location: United Center, Chicago Fee: $165 15104A Deadline: February 3 Transportation ACC: 4:45 pm / TBA - staff will call with the return time Key Contact: Sherrie Izban Shamrock Shuffle Ages 13 years & up Shuffle the night away to a DJ after enjoying dinner and prizes. This dance is included in the social club schedule. Ages
13-17 18 & up
Codes
15305A 15305B
Day: Friday Date: March 3 Time: 6:30-9:00 pm Location: Orland Park Civic Center Fee: $38 Deadline: February 10 Transportation ACC: Pick-up 5:15 pm / Drop-off 10:15 pm PREC: Pick- up at 5:45 pm/ Drop-off at 9:45 pm Key Contact: Sherrie Izban
Celebrity Look-A-Likes Dance Ages 13 & up It’s time to be a STAR! Come dressed as your favorite celebrity. Prizes will be awarded. Delicious snacks and drinks will be served. Ages
Codes
13-17 18 & up
25304A 25304B
Day: Friday Date: March 24 Time 7:00-9:30 pm Location: Joliet West Township High School Fee: $9 Deadline: March 3 Transportation ACC: Pick-up 6:00 pm/ Drop-off 10:30 pm PREC: Pick- up 6:30 pm / Drop-off 10:00 pm Key Contact: Sherrie Izban Spring Break Ages 5-17 years Spring break has finally arrived! LCSRA has several fun filled days that will keep you hoppin’ this week. It will be such an awesome time to hang out with friends and do the activities you love. Sign up for just one day or every day! A detailed schedule of the activities will be sent the week prior to the first event. Day
Monday Tuesday Wednesday Thursday Friday Monday Tuesday Wednesday Thursday
Date
March 27 March 28 March 29 March 30 March 31 April 10 April 11 April 12 April 13
Time: 10:00 am-3:00 pm Location: Varies LCSRA Resident Fee: $50 LCSRA Non-Resident Fee: $63 Deadline: March 6 Transportation ACC: Pick-up 10:00pm/ Drop-off 3:00pm PREC: Pick-up 9:30pm/ Drop-off 3:30pm Key Contact: Gina Petkus
Code
25201A 25201B 25201C 25201D 25201E 25201F 25201G 25201H 25201J
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April Pools Day Ages 18 years & Up Pool Tables, Dartboards, Bean Bags, Foosball Tables, Video Arcade….. Q Bar in Darien has it all. With 30 HDTV’s to watch sports, music and a full menu we are sure to have a fantastic fun filled Sunday afternoon. Program fee includes pool, stick rental and lunch. Day: Sunday Date: April 2 Time: 1:00-3:30 pm Location: Q-Bar in Darien Fee: $44 25111A Deadline: January 14 Transportation PREC: Pick- up Noon /Drop-off 4:30 pmACC: Pick-up 12:30 pm /Drop-off 5:00 pm Key Contact: Sherrie Izban Mexican Fiesta Dinner Dance Ages 13 years & Up Hola amigos! This evening fiesta with friends will include a Mexican dinner, your favorite DJ and a surprise giveaway. Ages
13-17 18 & up
Code
25306A 25306B
Day: Friday Date: April 7 Time: 6:30-9:00 pm Location: LWSRA Building, New Lenox Fee: $34 Deadline: March 17 Transportation PREC: Pick-up 5:30 pm /Drop-off 9:45 pm ACC: Pick-up 6:00 pm /Drop-off 10:15 pm Key Contact: Sherrie Izban Chicago Wolves Game Ages 8 years & up Don’t miss this action packed afternoon watching AHL hockey with your friends. Come cheer on your Chicago Wolves to victory as they take on the Rockford Ice Hogs. Fees include ticket, transportation and staff supervision. Participants should bring at least $15 for the concessions and extra money if they would like to purchase souvenirs. LCSRA will stay until the game is over. Staff will call parents or guardians before leaving the Allstate Arena with pick up times. Day: Sunday Date: April 9 25316A Game Time: 4:00 pm Location: Allstate Arena, Rosemont Fee: $41 Deadline: March 6 Transportation PREC: Pick- up 2:00 pm / Drop-off TBA ACC: Pick-up 2:30 pm/ Drop-off TBA Key Contact: Sherrie Izban
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Spring Formal Dinner Dance Ages 13 years & up Dinner, flowers and a picture are included in this spring-fling you are sure to enjoy with your friends! This dance is included in the social club schedule. Ages
13-17 18 & up
Codes
25305A 25305B
Day: Friday Date: May 12 Time: 6:30-9:00 pm Location: Apollo Recreation Center, Alsip Fee: $49 Deadline: April 21 Transportation PREC: Pick- up 5:00 pm / Drop-off at 10:15 pm ACC: Pick-up 5:30 pm / Drop-off 10:45 pm Key Contact: Sherrie Izban Chicago Cubs Game All ages, parent and siblings are welcome Take me out to the ball game! Come cheer on your Chicago Cubs as they take on the New York Yankees at The Friendly Confines of Wrigley Field. Program fee includes ticket and transportation. Please bring money for snacks and souvenirs. LCSRA will stay until the game is over. Staff will call parents or guardians before leaving Wrigley Field with pick up times. Day: Friday Date: May 5 Time: 1:20 pm game Location: Wrigley Field, Chicago Fee: $95 25415A Deadline: March 3 Transportation ACC: 11:00 am / TBA--staff will call with the return time Key Contact: Sherrie Izban
Year-round programs for individuals with disabilities
Compe t i t i v e Spor t s Saturday Night Fever Ages 13 years & up Here is your chance to show off your “moves” as you dance the night away to the latest tunes spun by Orland Park’s resident DJ. The evening includes dinner, dance contest and prizes. Ages
13-17 18 & up
Codes
25109A 25109B
Day: Saturday Date: May 20 Time: 6:30-9:00 pm Location: Civic Center, Orland Park Fee: $41 Deadline: April 14 Transportation ACC: Pick-up 5:15 pm /Drop-off 10:15 pm PREC: Pick- up 5:45 pm /Drop-off 9:45 pm Key Contact: Sherrie Izban Maple Tapping Ages 8-12 years A naturalist will guide you on a sugar maple walk around Hidden Oaks Conservation Area as winter comes to an end. Learn about the sweet history of making maple syrup. Learn how to tap a tree and get to taste the sap. Afterwards, join us of pancakes! Day: Saturday Date: March 18 Time: 10:00 am-Noon Location: Hidden Oaks Nature Center Fee: $15 25202A Deadline: March 4 Transportation ACC: TBD PREC: TBD Key Contact: Gina Petkus
Swim Team Ages 8 years & up Dive into the deep blue with the LCSRA Swim Team. Swim team is designated for swimmers who want to compete. Practices focus on swim endurance and stroke mechanics. The team competes in the Special Olympics qualifiers. Participants of this program MUST be able to swim the entire length of the pool in the lap lane without stopping. Day: Monday Date: January 9-May 1 Time: 7:00-8:00 pm Location: Bolingbrook Recreation & Aquatic Complex LCSRA Resident Fee: $144 15401A LCSRA Non-Resident Fee: $180 Deadline: January 2 No Class: January 16, February 20, March 6 or April 10 Key Contact: Sherrie Izban Swim Team Qualifiers Area Meet on February 11 District Meet on March 4 Track & Field Ages 8 years & up Join fellow athletes in training for the Area track meet, held at Thornwood High School in South Holland in May. Events include, but are not limited to, the 100-meter run, softball throw, standing long jump, shot put and the 400-meter relay. Athletes earning a gold medal at the Area meet qualify for the Special Olympics Summer Games, held at Illinois State University, June 9, 10 and 11. Be sure to wear a good pair of running shoes and no jeans may be worn. Time
6:00-7:00 pm 7:00-8:00 pm
Age
8-15 16 & up
Code
15418A 15418B
Day: Monday Date: February 20 – May 1 Location: Brooks Middle School Outdoor Track & ACC (Depending on weather) LCSRA Resident Fee: $111 LCSRA Non-Resident Fee: $139 Deadline: January 30 Transportation PREC Pick- up 5:30 pm / Drop-off 8:30 pm Key Contact: Sherrie Izban Track & Field Meet SO AREA SPRING GAMES on May 6
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SO Equestrian Ages 8 years & up The Equestrian Program offers Special Olympics athletes the experience of horseback riding as sport. Athletes must have already participated in therapeutic riding with a certified instructor. Equestrian is a challenging program, requiring athletes to both keep their focus and balance and to communicate well with their horse. Athletes will be train either the Western track or the English track in preparation for the STATE competition in October to display their abilities. Instructed by Kris Mondrella each rider will work towards his/her individual goals. Doctor’s consent is required in order to participate in this program. The required paperwork will be given to you upon registration. Dates
Feb 13-Mar 20 Feb 13-Mar 20 Apr 3-May 8 Apr 3-May8
Time
5:00-5:45 pm 5:45-6:15 pm 5:00-5:45 pm 5:45-6:15 pm
Code
25461A 25461B 25461C 25461D
Deadline Jan 23 Jan 23 Mar 13 Mar 13
Day: Monday Location: Ellis House & Equestrian Center in Minooka LCSRA Resident Fee: $325 LCSRA Non-Resident Fee: $375 Key Contact: Sherrie Izban
Bocce Ages 8 years & up Bocce, a favorite family game, is one of Special Olympics’ most relaxing competitive sports. Learn to toss, roll, hit and score points while learning the rules of the game. We will practice indoors, going outside when the weather permits. Participants will have the opportunity to compete in the Area Tournament. No jeans may be worn for this program. Day: Tuesday Date: January 31-April 4 Time: 6:00-7:00 pm Location: Annerino Community Center LCSRA Resident Fee: $84 15461A LCSRA Non-Resident Fee: $105 Deadline: January 17 Transportation: PREC: Pick-up 5:30 pm/ Drop-off 7:30 pm Key Contact: Sherrie Izban Bocce Tournament Tournament on April 8
Batting Practice Ages 8 years & up Swing…. Batter Batter…Swing!!!! Time spent in the batting cage is directly related to the success of a hitter during a game. There is no way around it, competing with the pitching machine is absolutely necessary for any hitter serious about improving his or her swing. This program is recommended for all participants who are registered to be a member of one of our LCSRA softball teams and want to improve their swing. Conducted by our LCSRA coaches, you will learn some great drills and games for the batting cage. Bring a water bottle and wear gym shoes. Athletic apparel is required. Participants are welcome to bring their own bat. Day: Tuesday Date: March 21-April 11 Time: 6:00-7:00 pm Location: Eich’s Sports Complex, Plainfield LCSRA Resident Fee: $36 25211A LCSRA Non-Resident Fee: $42 Deadline: February 28 Transportation ACC: Pick-up 5:15 pm/Drop-off 7:30 pm Key Contact: Sherrie Izban Softball Team Ages 13 years & up Grab your mitt and swing into spring as a member of the LCSRA Lions Softball Team! Over the course of the season, athletes work to improve their skills through practices and games against area special recreation associations. The team will compete in the ITRS tournament in July and the Area tournament in August at Inwood Park in Joliet. A detailed game schedule and uniforms are available the second week of practice. All uniforms must be returned at the end of the season. Times will vary, please refer to your detailed schedule. Day: Tuesday Date: April 18-August 1 Time: 6:30-8:00 pm Location: Wildcat Field LCSRA Resident Fee: $185 25411A LCSRA Non-Resident Fee: $233 Deadline: March 28 Transportation: PREC: Pick-up 6:00 pm / Drop-off 8:30 pm (varies for away games) Key Contact: Sherrie Izban Softball Tournaments SO Tournament on August 6 ITRS Tournament on July 16
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Year-round programs for individuals with disabilities
Soccer Team Ages 13 years & up We will be joining our friends from SEASPAR again this year to further develop our skills in soccer. Coaches focus on skills such as dribbling, passing and shooting. Teamwork and good sportsmanship are emphasized. Games are planned with other SRAs. Some games may be on different nights and times. We will also participate in the SO Tournament and the ITRS tournament in May. If our team earns a gold medal at the SO tournament we will advance to the Special Olympics Summer Games at Illinois State University, Friday, June 9 - Sunday, June 11. Bring a water bottle to practice. Athletes should wear athletic clothing and gym shoes. Day: Wednesday Date: March 1-May 17 Time: 5:30-6:30 pm Location: Lily Cache Soccer Field & ACC (for inclement weather) LCSRA Resident Fee: $161 25445A LCSRA Non-Resident Fee: $203 Deadline: February 15 Key Contact: Sherrie Izban Soccer Tournaments SO Tournament on May 7 ITRS Tournament on May 21 Gymnastics Team Ages 8 years & up Join the LCSRA Special Olympics Gymnastic Team. Gymnasts work on strength and coordination while training in tumbling, acrobatic skills, and limited apparatus work. This program is for participants who can sequence six or more skills to compose a routine for Special Olympics competition. Competition is in March in Palatine. Wear a leotard or fitted clothing. No jeans may be worn. Day: Wednesday Date: January 11-March 29 Time: 8:15-9:15 pm Location: Annerino Community Center LCSRA Resident Fee: $134 15419A LCSRA Non-Resident Fee: $168 Deadline: January 3 Key Contact: Sherrie Izban Gymnastics Competition SO Area Qualifier on March 5
Special Olympics Tennis Ages 8 years & up Serve it. Smash it. Love it. Those are just some tennis terms you will use when you join our newest Special Olympics sports team -- LCSRA Lions Tennis. You will perfect your individual skills and hopefully learn a few new ones in preparation for competition at the Special Olympics Area Tournament June 16 - 17. This program will be conducted outdoors. Wear appropriate athletic attire, bring a water bottle and your own tennis racket. Gold medal winners will advance to the STATE Tournament August 19 -20 in Bloomington. Day: Wednesday Date: April 19-June 14 Time: 4:30-5:30 pm Location: Annerino Community Center LCSRA Resident Fee: $40 25213A LCSRA Non-Resident Fee: $50 Deadline: April 5 Key Contact: Sherrie Izban Tennis Competition SO Area Qualifier on June 16-17
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Rhythmic Gymnastics Team Ages 8 years & up This sport combines the beauty and grace of dance and the agility of gymnastics. Gymnasts learn combination of ballet and dance, incorporating basic gymnastics skills and hand apparatus – such as rope, hoop, ball and ribbon. This program is for participants who can sequence six or more skills to compose a routine for Special Olympics competition. Competition is in March in Palatine. Wear a leotard or fitted clothing. No jeans may be worn. Level 1 2
LCSRA Spring Golf Club Ages 8 years & up LCSRA has “hooked” up with Mistwood Golf Course to provide our golfers with spring instruction. Staff will assist golfers with etiquette and rules of the sport, while moving you closer to the pin practicing at the driving range and then advancing to course play hopefully in the last two weeks. This is also great preparation for Special Olympics Competition in July. Ages
8 - 12 13 & up
Time
5:00-6:00 pm 6:15-7:15 pm
Date
May 3-June 7 May 3-June 7
Day: Wednesday Location: Mistwood Golf Club in Romeoville LCSRA Resident Fee: $37 LCSRA Non-Resident Fee: $47 Deadline: April 19 Key Contact: Sherrie Izban
Code
25451A 25451B
Special Olympics Bowling League Ages 8 years & up Calling all Special Olympic athletes! This is the opportunity for you to get involved in bowling on the competitive level. Coaches will give instruction on how to improve your game and prepare you for the competition in 2017. Bumpers will not be used for this program. The fee includes shoe rental, an hour on the lane. Day: Thursday Date: January 19-May 11 Time: 5:00-6:00 pm Location: Brunswick Zone, Romeoville LCSRA Resident Fee: $120 15407C LCSRA Non-Resident Fee: $153 No Class: March 9 & 16 Deadline: January 3 Key Contact: Sherrie Izban
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Time
6:00-7:00 pm 7:15-8:15 pm
Date
Jan 12- Mar 30 Jan 12- Mar 30
Day: Thursday Location: LCSRA Community Room LCSRA Resident Fee: $134 LCSRA Non-Resident Fee: $168 Deadline: January 3 Key Contact: Sherrie Izban
Gymnastics Competition SO Area Qualifier on March 5
Code
15419B 15419C
Year-round programs for individuals with disabilities
W EEKLY PROGRA MS FOR PART I CIPANT S W I TH AUT ISM Sensory Art Ages 6-21 years This program is specifically designed for youth on the autism spectrum. Each week, participants will create their own masterpieces using different textures to stimulate their senses. Some of the projects will use food to encourage participants to incorporate their sense of taste. Visual schedules will be provided if needed. Please wear older clothes that can get messy. Ages
6-17 18-21
Codes
15407A 15407B
Day: Saturday Date: February 4-February 25 Time: 10:00-11:00 am Location: Annerino Community Center LCSRA Resident Fee: $31 LCSRA Non-Resident Fee: $44 Deadline: January 21 Key Contact: Gina Petkus
Powerlifting Ages 16 years & up Sign up for the LCSRA powerlifting team. We will pump (clap!) you up. Through participation in this program, you will gain strength, build muscles and increaser your overall endurance. Besides focusing on overall weight training, we will concentrate on the bench press and dead lift for the Special Olympics qualifying meet in April. Please Note: LCSRA reserves the right to determine if this program is appropriate for an individual. Day: Thursday Date: February 9- April 27 Time: 5:00-6:15 pm Location: Bolingbrook Recreation & Aquatic Complex LCSRA Resident Fee: $104 15430A LCSRA Non-Resident Fee: $130 Deadline: January 19 Key Contact: Sherrie Izban Powerlifting Competition SO Area Qualifier on April 30
Musical Melodies Ages 6-21 years This program is specifically designed for youth on the autism spectrum. Individuals of all ages and all abilities can benefit from listening and playing music. Many studies have found that children with autism spectrum disorders (ASD) particularly respond well to music. This class will provide a variety of musical selections to listen to, play along with and move our bodies to. This class will be taught by a music therapist. Ages
6-17 18-21
Codes
15405A 15405B
Day: Saturday Date: March 11-April 8 Time: 10:00-11:00am Location: Annerino Community Center LCSRA Resident Fee: $59 LCSRA Non-Resident Fee: $74 Deadline: February 25 Key Contact: Gina Petkus
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Amazing Animals Ages 6-21 years This program is specifically designed for youth on the autism spectrum. Animals and humans share a special bond, this season we will learn all about that connection. Animals will be brought in for participants to see and feel. Participants will learn about the animals and their habitats through various hands on activities. Visual schedules will be provided if needed. Ages
Codes
6-17 18-21
25112A 25112B
Day: Saturday Date: April 22-May 13 Time: 10:00-11:00 am Location: Annerino Community Center LCSRA Resident Fee: $31 LCSRA Non-Resident Fee: $44 Deadline: April 8 Key Contact: Gina Petkus
Lunch Bunch Ages 6-21 years This program is specifically designed for youth on the autism spectrum. Come and bring your lunch, eat with friends and enjoy an afternoon of conversation. The focus of this group will be conversational skills, social skills and playing games. Please bring a sack lunch each class. Date
Feb 4-25 Feb 4-25 Mar 11-Apr 8 Mar 11-Apr 8 Apr 22-May 13 Apr 22-May 13
Ages
6-17 18-21 6-17 18-21 6-17 18-21
Day: Saturday Time: 11:00 am-12:00 pm Location: Annerino Community Center Key Contact: Gina Petkus
Deadline Jan 21 Jan 21 Feb 25 Feb 25 Apr 8 Apr 8
Codes
15413A 15413B 15413C 15413D 25413A 25413B
LCSRA Res Fee
LCSRA Non-Res Fee
$9 $9 $12 $12 $9 $9
$12 $12 $15 $15 $12 $12
Hang Time Ages 6-21 years This program is specifically designed as a social club for youth and teens that are on the autism spectrum. It is very important to enjoy a variety of recreational opportunities with our friends no matter what challenges we may have. This class is designed to teach the social skills that are needed for youth with autism to participate in social events. Each session will consist of in house skill building and one community outing that is specifically designed for youth/teens on the spectrum. All of the social skills that are taught will scaffold up to our outing. Field trip times will vary depending on availability. You will receive a schedule on the first day of the session. Date
Feb 4-25 Feb 4-25 Mar 11-Apr 8 Mar 11-Apr 8 Apr 22-May 13 Apr 22-May 13
Ages
6-17 18-21 6-17 18-21 6-17 18-21
Day: Saturday Time: Noon-1:00 pm Location: Annerino Community Center Key Contact: Gina Petkus
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Deadline Jan 21 Jan 21 Feb 25 Feb 25 Apr 8 Apr 8
Code
15304A 15304B 15304C 15304D 25442A 25442B
LCSRA Res Fee
LCSRA Non-Res Fee
$43 $43 $59 $59 $43 $43
$54 $54 $74 $74 $54 $54
Year-round programs for individuals with disabilities
SPECI AL EVENT S FOR PART I CIPANT S W I TH AUT ISM DuPage Children’s Museum Outing Ages 6-21 years The lights are turned down low and the crowds are at minimum. Come and play with us and experience a variety of activities for the senses. Augmentative communication devices are available at the exhibits. After exploring, there will be time to visit the museum store and purchase a souvenir. (Money must be provided from home.) Ages
6-17 18-21
Codes
Chords for Kids Ages 3 & up, Families Welcome Tonight we will be heading over to North Central College for a musical performance specifically designed for people with Autism. Participants are free to express themselves to the music. Songs range from instrumental pieces to popular tunes such as: “YMCA” and “Spider Pig” and songs from “SpongeBob SquarePants”. After the concert we will get a yummy treat and socialize with our friends. Ages
3-17 18-21
Codes
15441A 15441B
Day: Saturday Date: March 4 Time: 7:00-9:00 pm Location: North Central College, Naperville LCSRA Resident Fee: $21 Deadline: February 18 Transportation ACC: Pick-up 5:30 pm/ Drop-off 10:00 pm PREC: Pick-up 6:00 pm/ Drop-off 9:30 pm Key Contact: Gina Petkus
Ages
6-17 18-21
15105A 15105B
Day: Thursday Date: February 16 Time: 5:00-7:00 pm Location: DuPage Children’s Museum, Naperville LCSRA Resident Fee: $33 Deadline: February 2 Transportation ACC: Pick-up 4:00 pm/ Drop-off 8:30 pm PREC: Pick-up 4:30 pm/ Drop-off 8:00 pm Key Contact: Gina Petkus
Light it Up Blue Day Ages 6-21 People all around the world come together in April to spread awareness for Autism by wearing blue. Come dressed in your favorite blue attire to participate in various activities for Autism Awareness. We will be engaging in arts and crafts, gross motor activities, fine motor activities and socializing with our friends. Codes
25113A 25113B
Day: Sunday Date: April 2 Time: 2:00-4:00 pm Location: Annerino Community Center LCSRA Resident Fee: $21 Deadline: March 19 Key Contact: Gina Petkus
Autism Walk Ages 6 years & up - Families Welcome Autism Speaks Walk is the world’s largest fundraising event to support the diverse needs of the autism community. This grassroots movement is powered by parents of children on the autism spectrum, generating funds that fuel innovative research and make connections to critical lifelong supports and services. Come join TEAM LCSRA PUZZLE PIECES as we walk to make a difference. Fee includes donation, transportation, t-shirt and staffing. Feel free to raise more on your own to support Autism Speaks! Ages
6-17 18 & up
Codes
25114A 25114B
Day: Saturday Date: May 20 Time: 8:00 am-2:00 pm Location: Soldier Field, Chicago LCSRA Resident Fee: $42 Deadline: May 6 Transportation: ACC: Pick-up 6:00 am/ Drop-off 3:30 pm PREC: Pick-up 6:30 am/ Drop-off 3:00 pm Key Contact: Sherrie Izban & Gina Petkus
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LCSRA Code of Conduct form To ensure that all LCSRA participants enjoy programs and events to their fullest, and in the interest of safety, we use the following guidelines: Behavior LCSRA will attempt reasonable accommodations to enable participants to meet behavior expectations. Show respect to all participants, staff, and public. Listen to and comply with staff direction and program rules. Allow others in the program and others at public facilities to enjoy an activity without disruption (within reason). Refrain from using foul language, discussing inappropriate topics or other offensive behavior. Refrain from threatening or causing bodily harm or offensive physical contact to self, other participants, staff or public. Show respect to equipment, supplies, and facilities. Remain with the group at program. Additional rules are developed for specific programs as deemed necessary by the staff. If inappropriate behaviors occur, a prompt resolution will be sought specific to each individual. LCSRA reserves the right to dismiss participants whose behavior endangers the safety of themselves or others. Discipline Procedure Under ordinary and usual circumstances, if a participant exhibits inappropriate actions, the following general guidelines will be followed: 1. Warning 2. Time out or removal from the situation 3. Report to supervisor 4. Discussion with parent and implementation of a behavior plan Ordinarily, if a participant’s behavior does not improve depending on the severity of the act, the participant will be dismissed from the program. However, LCSRA reserves the right to dismiss a participant whose behavior endangers the safety of him/her self, others, or property, at any time. The Therapeutic Recreation Supervisor or Manager of Special Recreation will make final determination on dismissals. If a dismissal is made, refunds for unused sessions will be determined on an individual basis. I have read and agree to abide by this code of conduct.
_____________________________________________________________________________________________ Print Participant Name _____________________________________________________________________________________________ Signature of Participant Date _____________________________________________________________________________________________ Signature of Parent/ Guardian Date
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medication dispensing procedures Parental Procedures and Responsibilities The parent / guardian must: 1. Complete the Permission to Dispense Medication/Waiver and Release of All Claims form (below). 2. Complete and sign the Medication Dispensing Information form. 3. Deliver all medications to the program supervisor in the original prescription bottle (you can request an extra bottle from your pharmacy). The bottle must contain the participants name, medication, dosage, and time of day medication is to be given. 4. Verbally communicate with program supervisor any specific instructions regarding the medication. 5. Medication will not be administered if the above procedures are not completed. Staff Procedures and Responsibilities for Dispensing Medications Program supervisor / staff must: 1. Ensure that the Permission and Waiver to Dispense Medication Form and the Medication and Dispensing Information Form are fully completed and signed by the parent/guardian prior to the dispensing of any medication; all forms will be included in the program information given to staff. 2. Ensure that only authorized staff accept medication which may include: program manager or supervisor or program lead staff. 3. Verbally communicate with the parent/guardian regarding any specific instructions regarding the dispensing or storage of the medication. It is also the responsibility of the authorized staff who receive medication to properly store it in a locked cabinet or refrigerator as needed. It is extremely important that stored medication is out of reach of other patrons and participants in the program. 4. Obtain copies of all waivers, internal procedures, medication information forms, and medication logs when obtaining the prescription medication to be transported to the program site. All medication stored at a program site must be secured and only available to authorized staff. 5. Program coordinators / leaders responsible for dispensing medication must strictly follow all written instructions on the medical information form and information on the original prescription container. In the event that conflicting dispensing information exists, medication cannot be administered until the parent/guardian is reached in order to obtain specific instructions. 6. Unless otherwise arranged, only paid and trained park district staff will be allowed to dispense medication. 7. Staff responsible for dispensing medication will fully complete the medication log sheet. These logs will be turned into the program supervisor and will be kept and stored for at least three years upon the conclusion of the program.
PERMISSION TO DISPENSE MEDICATIONS
Waiver and Release of All Claims The Bolingbrook Park District and LCSRA will not dispense medication to a minor child or other participant until the Permission and Waiver to Dispense Medication and Medication Information Forms have been fully completed by a parent/guardian. Please review the Park Districts and LCSRA’s internal procedures on dispensing medication. I ________________________________________________the parent /guardian of ___________________________________ give permission to the staff of Bolingbrook Park District /LCSRA to administer the medications listed below to my child. I understand it is my responsibility to give the medication directly to the program staff in the original prescription containers. PARTICIPANTS NAME ______________________________________________________________________________________ NAME OF MEDICINE AND COMPLETE DOSAGE INSTRUCTIONS: ___________________________________ ___________________________________ ______________________________ ___________________________________ ___________________________________ ______________________________ ___________________________________ ___________________________________ ______________________________ In all cases the recommended dosage of any medication will not be exceeded. If after administering medication there is an adverse reaction, I give permission to the Bolingbrook Park District /LCSRA staff to secure from any licensed hospital physician and/or medical personnel any treatment deemed necessary for immediate care. I agree to be responsible for payment for any and all medical services rendered. Waiver and Release of All Claims I recognize and acknowledge that there are certain risks of physical injury in connection with the administering of medication to my minor child. Such risks include , but are not limited to , failing to properly administer the medication, failing to observe side effects, failing to assess and / or recognize an adverse reaction, failing to assess and/or recognize a medical emergency, and failing to recognize the need to summon emergency medical services. In consideration of the Bolingbrook Park District /LCSRA administering medication to my minor child , I do hereby fully release or discharge Bolingbrook Park District/LCSRA, and its officer, agents, volunteers and employees from any and all claims from injuries, damages, and losses I or my minor child may have (or accrue to me or my minor child), and arising out of, connected with, incidental to, or in any way associated with the administering of medication. ______________________________________________________________________________________________________________________________ Signature of Parent/ Guardian Date
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Medication Dispensing information This form must be completed annually OR if there are changes in medications
DATE COMPLETED: ___________________________________________________________________________ BACKGROUND INFORMATION Participant’s Name _____________________________________________________ Age ___________________ Address _____________________________________________________________________________________ Parent/Guardian’s Name _______________________________________________________________________ Daytime Phone __________________________________Other Phone __________________________________ Doctor’s Name___________________________________________Phone _______________________________
MEDICATION INFORMATION Name _________________________________________Dose _____________________Time________________ Dispensing & Storage lnstructions _________________________________________________________________________________________ _______________________________________________________________________________________________________________________ Possible Side Effects ____________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Name _________________________________________Dose _____________________Time________________ Dispensing & Storage lnstructions _________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Possible Side Effects ____________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Name _________________________________________Dose _____________________Time________________ Dispensing & Storage lnstructions _________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Possible Side Effects ____________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ OTHER INFORMATION __________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ I understand that it is my responsibility to give the medication directly to program staff with full instructions and in original prescription bottles. In all cases, medication dispensing can only be changed or modified by completing another Permissioin and Waiver to Dispense Medication Form and Medication Information Form. I hereby acknowledge that the above information provided for the dispensing of medication for my minor child is accurate. I also understand that it is my responsibility to inform the Park District if there are any changes in the dispensing of medication. Signature of Parent or Guardian ___________________________________________________________Date: _________________
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annual information form Please complete both sides of this form and return to LCSRA. This form must be completed on a yearly basis in order to continue participation in LCSRA programs and events. Please provide thorough answers. The information gathered from this form helps LCSRA to plan events and establish goals for programs. Please notify LCSRA of any changes to this form as the need arises. Participant Name ____________________________________________ Age _____ Birthdate _____/_____/_______ Male ____ Female ____ Address _________________________________________________ City _________________________State _______Zip ___________ Home Phone (_____)_____________________Work Phone (_____)_____________________Cell ( _____)_________________________ Parent/Guardian Name(s)______________________________________ __________________________________________________ Park District____________________________________________ Emergency Contact Name_______________________________Emergency Contact Number (_____ )___________ Email___________________ Emergency Contact Address__________________________________________________Relationship_____________________________ Participants School/Work_________________________________________________School/Work Phone (_____ )_____________________ Disability/Diagnosis__________________________________Description of Diagnosis___________________________________________ Teacher or Case Manager_____________________________________________________Are you a new participant?___________________ Doctor’s Name____________________________Address___________________________________Phone (_____ )________________ Will participant be responsible for self-medication during any programs? Will staff need to administer medication during any programs?
o YES
o NO
o YES
o NO
MEDICAL INFORMATION Please check the appropriate box. If “Yes,” please provide additional information. Has participant had any injuries or surgeries in the past year that might affect participation? o YES
o NO
_____________________________________________________________________________ If participant has Down Syndrome, have x-rays of the C-1 and C-2 vertebrae been taken and examined? o YES Is participant clear of Atlanto Axial Subluxation? o YES
o NO
o NO
Is participant subject to seizures? o YES o NO If yes, please note date of last seizure, type and frequency_______________________ Does participant have allergies? o YES
o NO If yes, please list__________________________________________________________
Does participant use any of the following: (Answer each item and provide additional comments in the space provided) Hearing Aid(s) o YES
o NO ____________________________________________________________________________________
Corrective Eyewear o YES
o NO _________________________________________________________________________________
Orthopedic or Prosthetic Devices o YES
o NO ___________________________________________________________________
Manual Wheelchair o YES
o NO _________________________________________________________________________________
Electric Wheelchair o YES
o NO _________________________________________________________________________________
Stroller o YES
o NO ________________________________________________________________________________________
Walker o YES
o NO ________________________________________________________________________________________
Cane o YES
o NO _________________________________________________________________________________________
CONSENT INFORMATION Transportation Permission
o YES
o NO
Publicity Photo Permission
o YES
o NO
Transport in Wheelchair o YES
Permission to Consult With Teacher
o YES
o NO
Permission to Consult With Caseworker
o YES
o NO
o NO
Parent’s Signature_____________________________________________________Date___________________________________ Participant’s Signature (over 21) ________________________________________Date____________________________________
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DAILY LIVING SKILLS/COMMUNICATION AND BEHAVIOR PLEASE CHECK THE APPROPRIATE BOX. IF
YES, PLEASE PROVIDE ADDITIONAL INFORMATION. Does participant require assistance with any of the following? Eating/drinking o YES o NO ____________________________________ Toileting o YES o NO ____________________________________ Dressing/undressing o YES o NO ____________________________________ Money Handling o YES o NO ____________________________________ Following Directions o YES o NO ____________________________________ Orientation to People, Place, Time o YES o NO ____________________________________ Anticipation of Safety Needs o YES o NO ____________________________________ Reading o YES o NO ____________________________________ Writing o YES o NO ____________________________________ Communication o YES o NO ____________________________________ Check any special toileting supplies that the participant uses: oDiaper oLeg bag oCatheter oOther (please list)______________________________ Check any communication tools that the participant uses: oAmerican Sign Language oCommunication Board/Book oPersonal Signs/Gestures Explain use:_____________________________________________________________________________________ Does the participant respond to specific behavioral techniques?o YES o NO ______________________________________ Does the participant respond to specific reinforcement devices? (i.e. food, toys, privileges)o YES o NO _______________________ Does the participant display unusual fears or concerns? o YES o NO ___________________________________________ Please indicate below any other information in regard to daily living skills, communication and behavior that might assist LCSRA staff: ____________________________________________________________________________________________ ____________________________________________________________________________________________
RECREATION PLEASE CHECK THE APPROPRIATE BOX. IF YES, PLEASE PROVIDE ADDITIONAL INFORMATION. SWIMMING Does participant require assistance with any of the following? Pool Entry o YES o NO ____________________________________ Submerging Body Parts o YES o NO ____________________________________ Strokes o YES o NO ____________________________________ Water Safety Awareness o YES o NO ____________________________________ Floating o YES o NO ____________________________________ Indicate what type, if any, of floatation device participant owns or will use: __________________________________________ Does participant require any of the following swim equipment? Ear Plugs o YES o NO ____________________________________ Nose Plugs o YES o NO ____________________________________ Other adapted swim equipment o YES o NO ____________________________________ Does participant require any adapted recreation equipment (i.e. bowling ramp)? o YES o NO If Yes, please describe____________________________________________________ Please note in the space below if participant requires a close staff ratio and why:__________________________________________ MEDICATION Drug Name
List all medications taken-even if not taken at program Dose
Time
Reason
Side Effects
I understand that it is my responsibility to give the medication directly to the LCSRA staff with full instructions in individual dosage containers, clearly labeled envelopes or in original prescription bottles. In all cases, medication dispensing can only be changed or modified by amending this form. I hereby acknowledge that the above information regarding medication dispensing is accurate. I also understand that it is my responsibility to inform LCSRA if any changes in the dispensing of medication occurs. In all cases, the recommended dosage of any medication will not be exceeded. If after administering medication there is an adverse reaction, I give my permission to LCSRA to secure from any licensed hospital physician and/or medical personnel any treatment deemed necessary for immediate care. I agree to be responsible for payment of any and all medical services rendered. I recognize and acknowledge that there are certain risks of physical injury in connection with the administering of medication to any participant. In consideration of LCSRA administering medication, I hereby fully release or discharge LCSRA and its officers, agents, employees and volunteers from any and all claims of injury, damages and losses that the participant may have, arising out of, connected with, incidental to, or in any way associated with the administering of medication. I further agree to indemnify, hold harmless and defend LCSRA, its officers, agents, employees and volunteers from any and all claims resulting from injuries, damages and losses sustained by the participant and arising out of, connected with, incidental to or in any way associated with the administering of medication.
Parent’s Signature__________________________________________________________Date_________________________ Participant’s Signature (over 21)______________________________________________Date_________________________ 30
SPECIAL OLYMPICS application
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ATHLETE INFORMATION
-
White Hispanic/Latino
Black/African American Other Asian
Zip Code
Parent’s/Guardian’s Home Telephone
State
Policy Number
Medical Insurance Company
-
-
)
-
D
Y
Sex (M or F)
Birthdate M M D Y
SO ILL Rev. 8-1-10
Date
Parent’s Email Address
Signature of Parent and/or Legal Guardian (Check appropriate box) Print Name
Date
Dosage
No No No No No No
Phone (
City
Address
Print Name
)
Doctor’s Signature
Examination Date
State
Zip
I have examined the above-named Entrant and, in my opinion, there is no mental or physical reason why he or she should not participate in the Special Olympics sports training and competition program. Further information will be forwarded if required. Current medication, if any, is specified with dosage on this application.
Date of last Tetanus shot:
Allergies to medication, if any:
Current Medication
Does the athlete have or is the athlete: Heart Problems Yes Diabetic Yes Epileptic/Seizures Yes Blind Yes Deaf Yes Hepatitis Yes Other
Does athlete have Down Syndrome? Yes No If yes, have x-rays of the C1-C2 vertebrae been taken and examined? Yes No Date of x-ray Is the athlete clear of Atlantoaxial Instability? Yes No
PLEASE CHECK MEDICAL INFORMATION
MEDICAL CLEARANCE
SO ILL OFFICE ONLY
Original parent/guardian and doctor signatures are required by the office of Special Olympics Illinois. Faxed signatures will not be accepted.
Athlete’s Email Address
Witness
Entrant
I, on my own behalf or as the undersigned parent and/or legal guardian of the above named applicant (hereafter referred to as the “Entrant”), hereby request permission for the Entrant to participate in Special Olympics programs. I acknowledge that Special Olympics will screen all entrants using the Sex Offender Public Registry and the Child Murder and Violent Offender Against Youth Registry and understand that entrants listed on either Registry will be denied participation. I affirm that this Entrant has never been on said Registries or, if Entrant was listed on either Registry but has since been removed, I will contact Special Olympics Illinois for instructions before submitting this application. I represent and warrant to you that the Entrant is physically and mentally able to participate in Special Olympics, and I submit herewith a subscribed medical certificate. I understand that if the athlete has Down Syndrome, he/she cannot participate in sports or events which, by their nature result in hyper-extension, radical flexion or direct pressure on the neck or upper spine unless a full radiological examination establishes the absence of Atlantoaxial Instability. I am aware that the sports and events for which this radiological examination is required are equestrian sports, artistic gymnastics, diving, pentathlon, high jump, alpine skiing, soccer, soccer skills, powerlifting squat and butterfly stroke and diving starts in swimming. On behalf of the Entrant and myself, I acknowledge that the Entrant will be using facilities at his/her own risk and I, on my own behalf, herby release, discharge and indemnify Special Olympics from all liability for injury to person or damage to property of myself and Entrant. In permitting the Entrant to participate, I am specifically granting permission to Special Olympics Illinois to use the likeness, voice and words of the Entrant in television, radio, films, newspapers, magazines and other media, and in any form not heretofore described, for the purpose of advertising or communicating the purposes and activities of Special Olympics and in appealing for funds to support such activities. I understand that by signing below I consent for the Entrant to participate in the Special Olympics Healthy Athletes Program that provides individual screening assessments of health status and health care needs. The Entrant has no obligation to participate and I understand the Entrant should seek his/her own medical advice and assistance and Special Olympics is not responsible for the Entrant’s health. If I am not personally present at Special Olympics activities in which the Entrant is to compete, so as to be consulted in case of necessity, you are authorized on my behalf and at my account to take such measures and arrange for such medical and hospital treatment as you may deem advisable for the health and well-being of the Entrant. I, THE UNDERSIGNED ADULT ENTRANT, have read and fully understand the I, THE UNDERSIGNED PARENT AND/OR GUARDIAN of the above specified provisions of the above release and/or have had them explained. I hereby agree that I Entrant, have read and fully understand the provisions of the above release and have will be bound thereby and I shall defend Special Olympics Illinois and hold it harmless explained them to said Entrant. I hereby agree that I and said minor will be bound from disaffirmation thereof. thereby, and I shall defend Special Olympics Illinois and hold it harmless from any disaffirmation thereof by said minor.
PARENT AND/OR GUARDIAN AUTHORIZATION AND MEDIA RELEASE
Emergency Contact Phone (
Person to be contacted in case of emergency
HEALTH INSURANCE & EMERGENCY INFORMATION (Required for Processing)
Ethnicity
Zip Code
Parent’s/Guardian’s City
Athlete’s City
State
Parent’s/Guardian’s (Please Circle One) Home Address
Athlete’s Mailing Address
Agency Name
Athlete Name (last name, space, first name)
Valid Application for Participation is mandatory for all competitors 605 E. Willow St. Normal, IL 61761-2682 309-888-2551
APPLICATION FOR PARTICIPATION IN SPECIAL OLYMPICS ILLINOIS
program Registration Form A n u p d at e d A n n u a l I n f o r m at i o n F o r m ( A I F ) i s d u e at t h e b e g i n n i n g o f e a c h y e a r .
Adult/Guardian______________________________________________________________Date ______/______/_______ (Please Print) First Last Address___________________________________________________City_______________________Zip____________ Phone PRIMARY: (________) _________-_____________
SECONDARY: (________) _________-_____________
Email Address Mail or bring to:
Annerino Community Center. 201 Recreation Drive, Bolingbrook, IL 60440 or Bolingbrook Recreation & Aquatic Complex. 200 S. Lindsey Lane, Bolingbrook, IL 60440
We invite registrations by people with disabilities. If you need assistance to participate, please mark an “x” in YES box. q YES CODE
PARTICIPANT’S/ PASS HOLDERS NAME
BIRTHDATE
GENDER
FEE
PROGRAM NAME
$1
$5
TIME
TOTAL
Would you like to make a donation to LCSRA’s Scholarship Fund? q NO q YES please select which amount:
q NO DAY
$10
Other ($
)
$
PHOTO: I understand that my child/ward or I may be photographed or videotaped while participating in an LCSRA program or facility. I give permission for photos and videotapes of my child/ward or me to be used to promote LCSRA. Such photos and videotape will remain the property of the LCSRA.
WAIVER AND RELEASE FOR PARTICIPANTS OR/BY PARENT Must be signed by parent if under 18. Please read this form carefully and be aware that in signing up and participating in this program/activity, you will 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/vehicle operation, 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 Lily Cache Special Recreation Association (LCSRA), including its officials, agents, volunteers and employees (hereinafter collectively referred as “LCSRA”). I do hereby fully release and forever discharge the LCSRA 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 online, your online signature shall substitute for and have the same legal effect as an original form signature. Signature Date (18 years or older or Parent/Guardian) Note: LCSRA does not carry medical or accident insurance for its participants. The cost of such insurance would make programs cost prohibitive. We suggest that you look at your own insurance policy to be sure you are adequately covered. LCSRA assumes no responsibility for personal injuries or loss of personal property. 33
registration information
R e g is t r a t i o n b e g i n s L csra resident: non - resident:
D ecember 7 december 2 1
The following registration procedures have been developed to provide equal registration preference to all resident ID card holders. 1. Phone registration will not be accepted unless otherwise noted. 2. Registration for programs will end 48 hours prior to the starting date unless otherwise noted. 3. There will be a $35 service charge for returned checks. NOTE: Fees are subject to change
Registration Procedures
1. Choose the program you want. 2. Complete the registration form. Include the code numbers indicated. 3. Make checks payable to LCSRA. Program fees may be combined for each family. 4. Sign the form. All adult participants must sign. Parent or guardian signature required for participants under 18 years of age. 5. Drop-off or mail your registration to any of the following locations: • Annerino Community Center: 201 Recreation Drive, Bolingbrook, IL 60440 • Bolingbrook Recreation & Aquatic Complex: 200 S. Lindsey Lane, Bolingbrook, IL 60440 LCSRA is not responsible for lost or misdirected mail. REFUND POLICY A full refund will be provided up to two (2) days before the registration deadline or in the event of no registration deadline, two (2) days before the start of an activity, event, or program. After that point, the refund will be pro-rated. To receive a Request Form, please visit or call one of the following locations: Annerino Community Center, 201 Recreation Dr. at 630.739.0272 or Bolingbrook Recreation & Aquatic Complex, 200 S. Lindsey Ln. at (630) 739-1700, or visit us online at b o l i ng bro o k par k s . org . Your receipt, cancelled check or proof of ID may be required. Once approved, refund checks will be mailed within fifteen (15) business days. The completed Refund Request Form must be returned to one of our customer service desks two (2) days before activity, event, or program start date or registration deadline.
SATISFACTION GUARANTEE At LCSRA, we strive to provide you with quality recreation activities, events and programs. We are confident that you will like these programs. So confident that we will ensure our promise to provide that high quality. The LCSRA guarantees that you will be satisfied with recreation classes, programs and services in which you participate. If after completing two classes you are not completely satisfied, tell us and we will arrange for you to do one of the following: 1. Repeat the class at no charge 2. Receive full credit that can be applied to any other class, program or service 3. Receive a full refund If you are not satisfied we kindly request input on how we can improve. To receive a Request Form, please visit or call one of the following locations: Annerino Community Center, 201 Recreation Dr. at 630.739.0272 or Bolingbrook Recreation & Aquatic Complex, 200 S. Lindsey Ln. at 630.739.1700, or visit us online at b ol i ngb rookp a rks.org. Your receipt, cancelled check or proof of ID may be required. Once approved, refund checks will be mailed within fifteen (15) business days. The completed Satisfaction Guarantee Request Form must be completed and returned to one of our customer service desks before the third class meeting. Satisfaction Guarantee does not apply to golf course green fees, pro shop merchandise, adult sport leagues, food or meals, beverages, facility memberships, daily admissions or tickets to entertainment or sporting events, as well as a few select programs.
Online Registration Resident ID card holders automatically receive their login and password to register online. If you are a Resident ID card holder and have not received your login information, please call our Application Support Specialist at (630) 783-6517. Nonresidents may register online by becoming Parkie’s E-club members. Parkie’s E-Club forms are available at all facilities or downloadable on the registration page at bolingbrookparks.org. Nonresidents simply have to fill the form out and drop it off at a Park District facility. Your login information will be emailed to you.
In order to protect your privacy, fax orders paid by credit card will no longer be accepted. Credit Cards will still be accepted in person or online.
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Year-round programs for individuals with disabilities
Lily Cache Special Recreation Association (LCSRA) represents the partnership between Bolingbrook and Plainfield Park Districts in their mission to serve the special needs population. Our goal is to provide recreational programs which build self-esteem and promote a lifetime of growth. LCSRA fosters an environment which allows individuals to discover their own unique potential and abilities. For more information, please visit us at lilycachesra.org
JOIN OUR MAILING LIST!
Be sure you’re on the list to receive our seasonal brochure full of the latest programs and events. Simply email Jill Mukushina at jmukushina@lilycachesra.org or call 630.783.6583.
LCSRA would like to thank its generous donors Bolingbrook Knights of Columbus Bolingbrook Lions Club Jacqueline and David Saylor Village of Bolingbrook
L i l y C a c h e S p e c i a l R e cr e a t i o n Ass o c i a t i o n An nerino Commun ity Cente r (ACC ) | 2 0 1 Re c reat i o n Dr i v e , Bo l i n g bro o k , I L | 6 3 0 . 7 3 9 . 1 1 2 4 | Re l a y : 8 00.526.0844 Plain f ie ld Re c reatio n/ A dminis trat i o n Ce n t e r ( P R E C ) | 2 3 7 2 9 W. O tt a wa St re e t , P l a i n fi e l d
lilycachesra.org
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201 Recreation Drive Bolingbrook, IL 60440 l i l ycach e sra .org
L o o k f o r D ay Camp Br och u r e t his sp ring. Regist rat io n begins A pr i l 2 2 l o o k for THE LCSRA summer guide t he w eek o f May 1
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