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Inclusion & Accommodation Request

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  2. Inclusion & Accommodation Request

    Longview Parks & Recreation invites individuals with disabilities or needing additional assisstance to join all recreation programs.  Reasonable accommodations will be provided to enable a person to participate at the most independent level.

  3. To better serve you, Inclusion & Accommodation Requests should be received at least two weeks before the program begins.  After receipt of this form, you will be contacted to discuss your request and gather additional information if necessary.

  4. Residency:*
  6. Have you participated in this program in the past?*
  8. Has a licensed health professional diagnosed the participant as having the above disability? *
  9. Does the participant take medications we should be aware of?*
  10. Does the participant have an Individualized Education Plan (IEP) or Behavior Plan?*
  11. Does the participant have seizures?*
  13. By placing your name in this field you therefore agree to the above stated information and allow your name to be your electronic signature.

  14. Leave This Blank:

  15. This field is not part of the form submission.