FALL 2015 GUIDE
REGISTRATION OPENS AUGUST 3
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 ”
PROGRAMS & OPPORTUNITIES for
• tots
• youth • teens FALL GUIDE
• adults • adapted & paralympic sports • inclusion • NASR
WATCH FOR THE WINTER/SPRING GUIDE • AVAILABLE DECEMBER 2015 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 Sports & Fitness . . . . . . . . . . . . . . . . . 5–6 Art & Leisure . . . . . . . . . . . . . . . . . . . 8–10 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 AUGUST 3! 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:
key to symbols Watch for these symbols throughout the guide.
RIDE
RIDE
Participants are asked to bring items
Please bring spending money Bus transportation service available/ offered Bus transportation service NOT available/offered
FUN AND ENJOYMENT FOR EVERYONE! See p 22 for details.
• Sensory integration • Transfer and seizure training • Safe places and standards for play • Conflict avoidance/crisis prevention • Cooperative games • Disability awareness • Character development • CPR and First Aid
Individualized Education Plan Therapeutic Recreation services can be listed as a related service on your child’s I.E.P. or student planning meeting. Please invite us to be a part of this process.
customer service
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.
815-987-8800
3 the team that delivers
FUN!
recreation coordinators
[JM]
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.
[KD]
[LW]
[PR]
[JM] Recreation Coordinator Jordan McDonald 815-987-1609 • jordanmcdonald@rockfordparkdistrict.org
[LW] Recreation Coordinator Lindsay Woods, CTRS 815-987-1604• lindsaywoods@rockfordparkdistrict.org
[KD] Recreation Coordinator Kuenzi Dearth, CTRS 815-987-1626 • kuenzidearth@rockfordparkdistrict.org
[PR] Recreation Coordinator Paula Reiter 815-987-1613 • paulareiter@rockfordparkdistrict.org
additional support staff [Danielle]
[Karin]
Senior Manager of Community Recreation Danielle Potter 815-987-1628 • daniellepotter@rockfordparkdistrict.org Therapeutic Recreation Manager Karin Kellogg 815-987-1601 • karinkellogg@rockfordparkdistrict.org Special Events & ADA Officer John Beck 815-987-1636 • johnbeck@rockfordparkdistrict.org
[Mariah]
fax
815-987-8877
[John]
online
Operations Assistant Mariah Anast 815-987-1606 • mariahanast@rockfordparkdistrict.org
rockfordparkdistrict.org/TR
NASR
4
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 rockfordparkdistrict.org • 815-987-8800
Belvidere Park District Special Recreation Dept belviderepark.org • 815-547-5711
Freeport Park District Special Recreation Dept freeportparkdistrict.org • 815-235-6114
NASR Fall Fun Day Welcome the fall weather and changing leaves by spending the day with your NASR friends. Join us for games, tie-dye, campfires, hayrides, and much more! You even get to cook your lunch over the campfire. Oakdale Nature Preserve, 4433 S Cranes Grove Rd, Freeport, IL
Program fee. . . . . . $15.00 AGES
DATES
TIME
DAY
ACTIVITY #
8+
Sept 12
11:00 am–2:00 pm
Sa
406602-91
NASR Friendsgiving
RIDE
Enjoy lunch and activities with your friends! We will prepare and eat our special lunch together, then participate in the fall craft, hike, or games. Note: Transportation will not be provided. Aldeen Park, 623 N Alpine Rd, Rockford, IL
Resident. . . . . . . . . $12.00 Non-resident. . . . . $17.00 AGES DATES 8+
Nov 7
TIME
DAY
ACTIVITY #
11:00 am–2:00 pm
Sa
406602-A1
customer service
815-987-8800
5
SPORTS & FITNESS
check out this guide for inclusion opportunities throughout the Park District
SAT WED
TUES
SPORTS & FITNESS AT A GLANCE YOUTH
TEEN
ADULTS
13–19
20+
PROGRAM
TIME
PAGE
5–12
Pool School
6:00–6:50 pm
5
AquaFitness
7:00–7:50 pm
6
Walking Club
5:30–6:30 pm
6
Buddy Soccer
times vary
6
13–22
Zumba
times vary
6
PLEASE NOTE: times are subject to change based on actual enrollment
Pool School Ready for an underwater adventure? Join the “school” of other fishes … rather, swimmers! Come out for a night of lessons, pool games, and open swim. We will set swimmer-specific goals, and continue to improve each week. Swimmers will learn the tools and skills to be a safe, independent swimmer. [LW] NOTE: If a swimmer is not completely toilet trained, swim diapers are required. Paper diapers of any type are not allowed in the pool. Swim pants or swim diapers must be reusable rubber or plastic pants that fit tightly around the waist and legs of the participant. These are similar to plastic pants that fit over cloth diapers. Millennium Center: 220 S Madison St, Rockford, IL
Resident. . . . . . . . . $78.00 Non-resident. . . . . $84.00
fax
815-987-8877
online
AGES
DATES
TIME
5–12
Sept 8–Oct 27
6:00–6:50 pm
rockfordparkdistrict.org/TR
DAY ACTIVITY# Tu
406150-91
6 SPORTS & FITNESS
ARTS & LEISURE
SPORTS & FITNESS
NASR
PROGRAM REGISTRATION OPENS AUGUST 3! Registration ends 8 days before the start of the program/event
AquaFitness Let’s dive into a night of swimming, socializing, and of course, splashing through water aerobics. Not only will we work on participant-specific goals, but we will also get to visit with friends in a “hot” environment. Note: If a swimmer is not completely toilet trained, swim diapers are required. Paper diapers of any type are not allowed in the pool. Swim pants or swim diapers must be reusable rubber or plastic pants that fit tightly around the waist and legs of the participant. These are similar to plastic pants that fit over cloth diapers. [LW] Millennium Center: 220 S Madison St, Rockford, IL
Resident. . . . . . . . . $78.00 Non-resident. . . . . $84.00 AGES
DATES
TIME
13+
Sept 8–Oct 27
7:00–7:50 pm
DAY ACTIVITY# Tu
506349-91
Let’s dance! Zumba is a fusion of Latin and modern dance themes, creating a fun, dynamic, and exciting workout. Check out this modern, fast-paced dance workout. Please wear tennis shoes and appropriate workout attire. [LW]
FUN AND ENJOYMENT FOR EVERYONE! See p 22 for details.
Rockford Dance Company in Riverfront Museum Park, 711 N Main St, Rockford, IL
SOCIAL
Buddy Soccer What is better the second time around? Buddy Soccer! Join us in our second season of a six-week-long, non-competitive recreational league for individuals of all abilities. Each player with a disability related need will be paired with a “buddy” to assist in creating a fun and successful opportunity. The program will focus on experience of team play, skill development, hand eye coordination, participation, and independence. All involved will have fun as friendships are built and skills are developed. [LW] Note: Registration closes Monday, August 24.
ADAPTED SPORTS
Zumba
Indoor Sports Center (ISC), 8800 E Riverside Blvd, Loves Park, IL
Resident. . . . . . . . . $30.00 Non-resident. . . . . $35.00 Buddies . . . . . . . . . . . free DAY ACTIVITY#
Resident. . . . . . . . . $24.00 Non-resident. . . . . $34.00 AGES
DATES
TIME
DAY ACTIVITY#
5–12
Oct 3–Nov 21
11:30 am–12:20 pm
Sa
406151-A1
13+
Oct 3–Nov 21
12:30–1:20 pm
Sa
506351-A1
Walking Club Did you know that speed walking for an hour can burn more than 200 calories? Lace up your walking shoes and join us for Walking Club! Lets walk away a few extra pounds while visiting with friends and window shopping. We will keep track of our laps, and tally them at the end of each night in order to give us a goal to work towards the next week. See how many miles you can squeeze in during the hour! [LW]
AGES
DATES
TIME
5–12
Sept 9–Oct 28
5:30–6:15 pm
W
406155-01
CherryVale Mall, 7200 Harrison Ave, Cherry Valley, IL
13–22
Sept 9–Oct 28
6:30–7:15 pm
W
406155-02
Resident. . . . . . . . . $12.00 Non-resident. . . . . $16.00
Buddy registration info 16+
Sept 9–Oct 28
5:30–7:15 pm
W
406155-BB
AGES
DATES
TIME
13+
Nov 10–Dec 15
5:30–6:30 pm
customer service
815-987-8800
DAY ACTIVITY# Tu
506355-B1
7
Parents — need a place for the kids to burn off some energy after school? Peer Play
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 Inclusion@rockfordparkdistrict.org for locations and availability. [KD]
Contact us today for more information! call
fax
815-987-8877
online
rockfordparkdistrict.org/TR
SAT
ARTS & LEISURE SKILL DEVELOPMENT
THURS
WED
8 TOTS
YOUTH
TEEN
ADULTS
3–5
6–12
13–19
20+
PROGRAM
TIME
PAGE
Fall Gardening
6:00–7:15 pm
8
Edible Creations
6:00–8:00 pm
9
Art at the Arc — Open Studio
1:00–4:00 pm
9
18+
Art at the Arc — Skills Class
4:00–5:30 pm
9
18+
Edible Creations
6:00–8:00 pm
9
Art at the Arc — Open Studio
1:00–4:00 pm
9
18+
Art at the Arc — Skills Class
4:00–5:30 pm
9
18+
Chance to Dance
times vary
10
ARTS & LEISURE AT A GLANCE Fall Gardening Though it’ll start to cool down, we’re still digging in! Thanks to Nature Quest Summer Camp and the National Parks and Recreation Association, we’ll have a beautiful vegetable garden to care for and maintain in the fall. We will even make some snacks and sample home grown goodness! No worries, we can still continue to care for our flowers, too. We’re going to host a season-ending Harvest Day at Linda K. White Center to celebrate all the hard work that went into the new and amazing garden — more information will be forthcoming. [PR] Aldeen Park, 623 N Alpine Rd, Rockford, IL
Resident. . . . . . . . . $12.00 Non-resident. . . . . $17.50 AGES
DATES
TIME
DAY
ACTIVITY#
20+
Aug 12–26
6:00–7:15 pm
W
506332-81
customer service
815-987-8800
ARTS & LEISURE
9
Art at the Arc – Skills Class
FUN AND ENJOYMENT FOR EVERYONE! See p 22 for details.
NOTE: Need a ride from Art at the Arc? Let us know, and we’ll get you there! Pick-up at the Linda K White Center after cooking.
NOTE: P lease only sign up for one day per week to allow others an opportunity to participate. The Arc: 1222 E State St, Rockford, IL
Resident. . . . . . . . . $20.00 Non-resident. . . . . $28.00 AGES
DATES
TIME
DAY
ACTIVITY#
Resident. . . . . . . . . $26.00 Non-resident. . . . . $36.00
18+
Sept 2–23
4:00–5:30 pm
W
506340-91
18+
Sept 3–24
4:00–5:30 pm
Th
506340-92
18+
Sept 30–Oct 21
4:00–5:30 pm
W
506340-A1
18+
Oct 1–22
4:00–5:30 pm
Th
506340-A2
18+
Oct 28–Nov 18
4:00–5:30 pm
W
506340-B1
18+
Oct 29–Nov 19
4:00–5:30 pm
Th
506340-B2
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Sept 2–23
6:00–8:00 pm
W
506331-91
20+
Sept 3–24
6:00–8:00 pm
Th
506331-92
20+
Sept 30–Oct 21
6:00–8:00 pm
W
506331-A1
20+
Oct 1–22
6:00–8:00 pm
Th
506331-A2
Art at the Arc – Open Studio Open Studio is an ideal program for artists 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. Basic supplies will be provided, but artists are encouraged to bring additional supplies. [JM]
The Arc: 1222 E State St, Rockford, IL
SOCIAL
NOTE: P lease only sign up for one day per week to allow others an opportunity to participate.
ARTS & LEIISURE
Aldeen Park, 623 N Alpine Rd, Rockford, IL
SPORTS & FITNESS
Looking 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. If you have special diet needs, contact the program coordinator prior to the first week of the program. [PR]
NASR
Edible Creations
Are you an artist? Have you always wanted to be one? Then you need to join the 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]
Resident. . . . . . . . . $24.00 Non-resident. . . . . $34.00
815-987-8877
online
DATES
TIME
DAY
ACTIVITY#
18+
Sept 2–23
1:00–4:00 pm
W
506340-93
18+
Sept 3–24
1:00–4:00 pm
Th
506340-94
18+
Sept 30–Oct 21
1:00–4:00 pm
W
506340-A3
18+
Oct 1–22
1:00–4:00 pm
Th
506340-A4
18+
Oct 28–Nov 18
1:00–4:00 pm
W
506340-B3
18+
Oct 29–Nov 19
1:00–4:00 pm
Th
506340-B4
18+
Jan 6–27
1:00–4:00 pm
W
506340-11
18+
Jan 7–28
1:00–4:00 pm
Th
506340-12
rockfordparkdistrict.org/TR
ADAPTED SPORTS
fax
AGES
10 ARTS & LEISURE 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. [JM] Rockford Dance Company in Riverfront Museum Park: 711 N Main St, Rockford, IL
Resident. . . . . . . . . $56.00 Non-resident. . . . . $72.00 AGES
DATES
TIME
DAY ACTIVITY#
3–12
Oct 3–Nov 21
10:30–11:20 am
Sa
406142-A1
13+
Oct 3–Nov 21
11:30 am–12:20 pm
Sa
506342-A1
ADAPTED SPORTS
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
NASR
Chance to Dance
customer service
815-987-8800
11 TEEN
ADULTS 20+
TIME
PAGE
13–19
Teens on the Town: Spooky Bingo
6:30–9:00 pm
13
Teens on the Town: Halloween Bash
6:30–9:00 pm
14
Teens on the Town: Comedy Movie and Dinner Night
6:30–9:00 pm
14
Be Social: Atwood Adventures
6:30–9:00 pm
14
Be Social: Comedy Movie and Dinner Night
6:30–9:00 pm
14
Be Social: TGIF Fun!
6:30–9:00 pm
15
Be Social: Spooky Bingo
6:30–9:00 pm
15
Be Social: Halloween Bash
6:30–9:00 pm
15
Be Social: Dine Out at Capri
6:30–9:00 pm
16
Be Social: Jewelry Jubilee and Holiday Craft
6:30–9:00 pm
16
Be Social: Winter Wonderland Dance
6:30–9:00 pm
16
Teens on the Town: Volcano Falls
1:00–3:00 pm
13
Teens on the Town: Bowling
1:00–3:00 pm
13
Be Social: Lockwood Cookout and Hayride
12:30–3:00 pm
15
Be Social: Bowling
1:00–3:00 pm
15
Be Social: NIU Football Game
TBD
15
Be Social: Holiday Shopping and Lunch
12:00–2:30 pm
16
Be Social: Jewelry Jubilee and Holiday Craft
1:00–3:00 pm
16
SAT
FRI
PROGRAM
Serving the community for over 40 years fax
815-987-8877
online
rockfordparkdistrict.org/TR
SOCIAL
SOCIAL PROGRAMS AT A GLANCE
12 SOCIAL PROGRAM REGISTRATION OPENS AUGUST 3! NASR
Registration ends 8 daysbefore the start of the program/event
FUN AND ENJOYMENT FOR EVERYONE!
ADAPTED SPORTS
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
See p 22 for details.
Teen and Adult Social Programs 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 Resident. . . . . . . . . $12.00 Non-resident. . . . . $17.00 Transportation • $4.00 per social event
Registration Deadline
• Residents: We provide door-to-door transportation for participants who are Rockford Park District residents.
• Please also note, the registration deadline is eight business days prior to the event.
• Non-residents: Pick-up points are available for participants who are non-residents. Please choose one of the following pick-up points
• To be officially registered, a program registration form must be completed and signed. Payment must also be made at the time of registration.
• 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.
• 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.
key to symbols Watch for these symbols throughout the guide. 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.
RIDE
RIDE
Participants are asked to bring items
Please bring spending money Bus transportation service available/offered Bus transportation service NOT available/offered
customer service
815-987-8800
SOCIAL 13 Teens on the Town
FEE FOR EACH PROGRAM, UNLESS OTHERWISE LISTED Resident. . . . . . . . . $12.00 Non-resident. . . . . $17.00 Volcano Falls
Lace up those bowling shoes, it’s time to roll. We will bowl as many games as possible. Shoes, balls, and ramp will be provided, but feel free to bring your own. Please bring money if you would like a snack ($5.00 to $10.00 recommended). Park Lanes, 5318 N 2nd St, Loves Park, IL
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
Oct 17
1:00–3:00 pm
Sa
406221-A1
Spooky Bingo
RIDE
Volcano Falls Adventure Park, 7602 Rock Valley Pkwy, Loves Park, IL
RIDE
Grab your lucky charms and friends — it’s time for spooky bingo! There will be plenty of prizes to win, and a “monster” of a good time! We will enjoy a special Halloween dinner and dessert, then play bingo. Costumes are welcome! Note: This is a drop-in program; transportation will not be provided. Aldeen Park, 623 N Alpine Rd, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
Sept 19
1:00–3:00 pm
Sa
406221-91
13–19
Oct 23
6:30–9:00 pm
F
406221-A2
ARTS & LEIISURE
Where can you get a hole-in-one, play laser tag, win at arcade games, get cool prizes, and knock one out of the park? Volcano Falls! Complete the afternoon with a delicious treat from the snack bar ($5.00 to $10.00 recommended). Your choice of a round of mini-golf or laser tag is included in the price.
RIDE
SPORTS & FITNESS
Locations vary by program
Bowling
NASR
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]
SOCIAL ADAPTED SPORTS
14 SOCIAL
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
NASR
Halloween Bash
RIDE
Ghouls and guys — come on down for our annual Halloween Bash! It’s going to be a Monster Mash at our Halloween Bash. Who’s gonna have the best costume this year? You’ll find out once you’re here! Snacks and beverages will be provided.
Kick back and relax as we settle in to watch a comedy that will have everyone laughing and cheering for more! The audience will pick the movie for the evening. We will also also enjoy a delicious meal, beverage, and a sweet treat!
Webbs Norman Center, 401 S Main St, Rockford, IL
Aldeen Park, 623 N Alpine Rd, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
13–19
Oct 30
6:30–9:00 pm
F
406221-A3
13–19
Nov 13
6:30–9:00 pm
F
406221-B1
#throwback Costume
See pg 4 for additional social opportunities
Ball 2008
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 Resident. . . . . . . . . $12.00 Non-resident. . . . . $17.00 Atwood Adventures
ADAPTED SPORTS
Comedy Movie and Dinner Night
RIDE
Comedy Movie and Dinner Night
RIDE
Before the weather turns cold, come out and enjoy beautiful Atwood Park. We will hike the awesome trails, visit the Birds of Prey, explore the accessible tree house, and stargaze under the night sky. We will end our evening with a campfire and s’mores! All activities will be guided by the fantastic Atwood staff. Please dress accordingly for weather and outdoor activities. Atwood Center, 2685 New Milford School Rd, Rockford, IL
RIDE
Kick back and relax as we settle in to watch a comedy that will have everyone laughing and cheering for more! The audience will pick the movie for the evening. We will also also enjoy a delicious meal, beverage, and a sweet treat! Note: To allow everyone the opportunity to participate, please sign up for only one of these programs. Aldeen Park, 623 N Alpine Rd, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Sept 25
6:30–9:00 pm
F
506322-92
20+
Sept 18
6:30–9:00 pm
F
506322-91
20+
Nov 13
6:30–9:00 pm
F
506322-B2
customer service
815-987-8800
SOCIAL 15 check us out on facebook! Therapeutic Recreation —
Lockwood Cookout and Hayride
NASR
Rockford Park District
RIDE
Lockwood Park, 5201 Safford Rd, Rockford, IL
Resident. . . . . . . . . $17.50 Non-resident. . . . . $24.50 AGES
DATES
TIME
DAY
ACTIVITY#
20+
Sept 26
12:30–3:00 pm
Sa
506322-93
Are you ready for some football? The NIU Huskies are going head-to-head with the Ball State Cardinals. Put on your red and black, it’s gonna get wild! Bring money for food and souvenirs ($20.00 to $30.00 recommended). Tailgating snacks will be provided. No door-to-door transportation for this event will be provided, however, pick-up points will be utilized. Pick-up point locations are: Webbs Norman Center (401 S Main St, Rockford), Meadow Mart (N Second St and Windsor Rd, Loves Park), Linda K. White Center at Aldeen Park (623 N Alpine Rd, Rockford), or Phillips 66 (4402 Linden Rd). Note: The time for the game is TBA. Please plan accordingly for a day or evening game.
RIDE
Thank goodness it’s Friday! We will celebrate this Friday evening by getting together for a fun-filled night of activities that may include indoor and outside games, Xbox, karaoke, crafts, music, dancing, socializing, and of course, great snacks! Note: To allow everyone the opportunity to participate, please sign up for only one of these programs. Aldeen Park, 623 N Alpine Rd, Rockford, IL
DATES
TIME
DAY
ACTIVITY#
20+
Oct 2
6:30–9:00 pm
F
506322-A1
20+
Oct 16
6:30–9:00 pm
F
506322-A4
NIU Huskie Stadium, 1245 Stadium Drive, Dekalb, IL
Resident. . . . . . . . . $30.00 Non-resident. . . . . $42.00 AGES
DATES
TIME
DAY
ACTIVITY#
20+
Oct 10
TBD
Sa
506322-A3
Spooky Bingo
RIDE
Grab your lucky charms and friends — it’s time for spooky bingo! There will be plenty of prizes to win and a “monster” of a good time! We will enjoy a special Halloween dinner and dessert, then play bingo. Costumes are welcome! Aldeen Park, 623 N Alpine Rd, Rockford, IL
RIDE
Note: To allow everyone the opportunity to participate, please sign up for only one of these programs. Park Lanes, 5318 N 2nd St, Loves Park, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Oct 23
6:30–9:00 pm
F
506322-A5
Halloween Bash
RIDE
Ghouls and guys — come on down for our annual Halloween Bash! It’s going to be a Monster Mash at our Halloween Bash. Who’s gonna have the best costume this year? You’ll find out once you’re here! Snacks and beverages will be provided. Webbs Norman Center, 401 S Main St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Oct 3
1:00–3:00 pm
Sa
506322-A2
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Oct 24
1:00–3:00 pm
Sa
506322-A6
20+
Oct 30
6:30–9:00 pm
F
506322-A7
fax
815-987-8877
online
rockfordparkdistrict.org/TR
ADAPTED SPORTS
Lace up those bowling shoes, it’s time to roll. We will bowl as many games as possible. Shoes, balls, and ramp will be provided, but feel free to bring your own. Please bring money if you would like a snack ($5.00 to $10.00 recommended).
SOCIAL
AGES
Bowling
RIDE
ARTS & LEIISURE
TGIF Fun!
NIU Football Game
SPORTS & FITNESS
Spend an afternoon down on the farm at Lockwood Park. We will cook out and have a picnic lunch, take a tractor-drawn hayride, and tour the barns to see the animals and beautiful horses. It’s bound to be a great time, so tell all your friends! Please dress appropriately for the weather and outdoor activities.
16 SOCIAL
NASR
Dine Out at Capri
PROGRAM REGISTRATION OPENS AUGUST 3!
RIDE
Registration ends 8 days before the start of the program/event
On top of spaghetti, all covered with cheese, I crave a big meatball, let’s go to … Capri! We will have a great time dining together at this wonderful restaurant. Bring approximately $15.00 to cover a family style dinner of pasta and meatballs, pizza bread, garlic bread, salad, beverages, and dessert!
SPORTS & FITNESS
Capri Restaurant, 313 E State St, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Nov 6
6:30–9:00 pm
F
506322-B1
Holiday Shopping and Lunch
RIDE
With the holidays right around the corner, let’s get together and get a jump on our shopping this year! CherryVale Mall is the perfect spot to pick up gifts for everyone and anyone. We’ll grab some lunch at the food court so we don’t drop while we shop. Be sure to bring your “nice” list, and money for lunch and shopping ($10.00 recommended for lunch).
ADAPTED SPORTS
SOCIAL
ARTS & LEISURE
CherryVale Mall, 7200 Harrison Ave, Cherry Valley, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Nov 14
12:00–2:30 pm
Sa
506322-B3
Jewelry Jubilee and Holiday Craft
RIDE
It’ll be off the chain … or on it. Create a masterpiece for yourself, or as a gift for a loved one just in time for the holidays. We will also be making a holiday craft for you to take home and decorate for the season! A light snack will be provided. Note: To allow everyone the opportunity to participate, please sign up for only one of these programs Aldeen Park, 623 N Alpine Rd, Rockford, IL
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Nov 20
6:30–9:00 pm
F
506322-B4
20+
Nov 21
1:00–3:00 pm
Sa
506322-B5
Winter Wonderland Dance
key to symbols
RIDE
Watch for these symbols throughout the guide.
Why walk, when you can dance in a winter wonderland! We’ll provide the grooves, you provide the moves! Be dressed to impress, as our dance will be semi-formal for the holidays. Appetizers and beverages will be provided. Webbs Norman Center, 401 S Main St, Rockford, IL
RIDE
AGES
DATES
TIME
DAY
ACTIVITY#
20+
Dec 4
6:30–9:00 pm
F
506322-C1
RIDE
Participants are asked to bring items
Please bring spending money Bus transportation service available/offered Bus transportation service NOT available/offered
customer service
815-987-8800
17
Adapted Sports and Paralympic Sports 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
rockfordparkdistrict.org/TR
ADAPTED SPORTS
ADAPTED SPORTS AT A GLANCE
18 ADAPTED SPORTS
NASR
Paralympic Boccia
RIDE
Maybe you’re a pro looking to hone your skills, or maybe you’ve always wanted to learn how to play — whatever the case may be, now is your chance! Come learn all the rules and strategies of Boccia. Athletes practice to compete at different regional and national tournaments. [LW] NOTE: Weekend tournaments once per month, dates to be determined Indoor Sports Center (ISC), 8800 E Riverside Blvd, Loves Park, IL
SOCIAL
ARTS & LEISURE
SPORTS & FITNESS
Res player. . . . . . . . $24.00 Non-res player. . . . $34.00 AGES
DATES
TIME
DAY
ACTIVITY#
All ages
Sept 23–Dec 9
4:00–6:00 pm
W
606461-91
Wheelchair Basketball 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 “Jr.Varsity” 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 Paula Reiter at 815-987-1613 for more information. [PR] Indoor Sports Center (ISC), 8800 E Riverside Blvd, Loves Park, IL
Res player. . . . . . . . $60.00 Non-res player. . . . $84.00 AGES
DATES
TIME
DAY
ACTIVITY#
6–HS
Sept 29, 2015– Apr 12, 2016
6:15–8:15 pm
Tu
606460-A1
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.
This could be you! Join the nationally recognized Jr. Chariots team! Beginner to advanced, recreational to competitive — we want you! Eligibility requirements:
ADAPTED SPORTS
• have mobility needs (may or may not use a wheelchair on a daily basis) • are visually impaired • have an amputation • 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.
We’ll teach you the skills you need to take your game to the next level! 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
• tricycles
• portable pool lift
• bicycles
• all-terrain joggers
• power soccer equipment
• hand cycles
• bowling ramps
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
pool lift • for use at any RPD public pool
Call the Therapeutic Recreation department at 815-987-1606 for more information. fax
815-987-8877
online
rockfordparkdistrict.org/TR
20 inclusion services What is inclusion? Inclusion 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.
HOW?
INCLUSION SERVICES
The Rockford Park District welcomes and supports the participation of individuals with disabilities in all programs and services. • Consultation on activity modification
A PARENT’S GUIDE TO INCLUsION
• Disability awareness training
STEPS TO RECEIVE INCLUSION SUPPORT
• Behavior modification support
1. Register for desired Rockford Park District program at Webbs Norman Center, Carlson Ice Arena, or www.rockfordparkdistrict.org
• Observation and evaluation • Visual systems and sensory equipment/toys
2. Check “yes” where the registration form states, “…does the participant have a disability or medical conditions that may require assistance or accommodation?”
• Sign language interpreters • Adapted equipment (sleds, skate walkers, hand cranked bicycles, sport wheelchairs)
3. A team member from Inclusion Services will contact you within 48 hours to assess needs, level of support, and an appropriate start date
• Varying levels of staff support
Popular programs in which individuals with disabilities have been included: • Lessons (swimming, hockey, ice skating, horseback riding, tennis, golf) • Day and residential summer camps (Summer Blast, Nature Quest, Camp Lone Oak, Pony Camp, Adventure Club, Camp Winnebago) • Neighborhood programs (Playgrounds, Lewis Lemon and Washington Park community centers) • Environmental education and recreation • Youth sports
2. Obtain and organize any additional information, equipment, and additional support staff (if applicable) 3. Notify program staff of participant’s needs and their role in supporting the participant in their program 4. Communicate with family any updates, changes, or information they need to be made aware of before the start of the program
6. Recommendations will be addressed based on the participant’s progress or level of success in the program
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 • Creating and training staff on an enhanced visual system for a camper with a visual impairment
• Providing a sign language interpreter for a teen at horseback riding lessons
1. Contact family/guardian to complete full assessment
5. Maintain communication with parents/guardians, support staff, and program staff, throughout the course of the program
• Rec nights
• Trained staff supported a camper with an attention deficit disorder by providing additional supports such as redirection and positive reinforcements at a sports camp
INCLUSION SERVICES ROLES
PARENTS’ ROLE 1. Verify the participant meets minimum eligibility requirements of program (i.e., age, registration, and level of participation) 2. Keep in mind, recreation programs and activities are voluntary in nature. Participation will be encouraged and aided, but not forced. 3. Communicate openly with inclusion services staff by providing pertinent information on participant’s needs for successful inclusion 4. Communicate absences to inclusion and/or program staff in advance 5. Provide constructive feedback on participant’s progress and response to inclusion effort
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 Inclusion@rockfordparkdistrict.org
Therapeutic Recreation – Rockford Park District Buddy Baseball/Basketball – Rockford Park District
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
rockfordparkdistrict.org/TR
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
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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________/______/________ Sex M
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
rockfordparkdistrict.org/TR
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 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
State ZIP /
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 City State
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.
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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
rockfordparkdistrict.org/TR
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
FALL 2015 GUIDE
… MARK
YOUR C ALE
NDARS!
F EVRE E EN T!
FREE! Mornings of Fun for Everyone the following Saturdays in 2015: Aug 8 and Oct 10; 9:00–10:00 am Discovery Center Museum, 711 N Main St, Rockford, IL 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 sues@discoverycentermuseum.org.
CUSTOMER SERVICE • SE HABLA ESPAÑOL 815-987-8800 • rockfordparkdistrict.org/TR
PRESENTED BY
REGISTRATION OPENS AUGUST 3