splashtastic family swim - wssra · splashtastic family swim moms, ... jenny meza natalie meza...
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PROGRAM GUIDESPLASHTASTIC FAMILY SWIM
MOMS, DADS, SIBLINGS- GRAB YOUR SWIMSUITS AND TOWELS! Come out and enjoy swimming as a whole family
PAGE 8
WINTER FESTCrafts, games & sledding!
GOLF “PAR-TEE”Enjoy 3 hours of golf fun: driving range, swing evaluation,
longest drive competition, virtual golf, drinks, refreshments & tips from a pro.
PAGE 28
SUMMER DAY CAMP 2011REGISTRATION FORM INSIDE!
2 WSSRA.NET
WEST SUBURBAN SPECIAL RECREATION ASSOCIATION2915 Maple Street, Franklin Park, IL 60131
847.455.2100 (voice or TTY)Office Hours: 8:30 AM - 5:00 PM
Monday through Friday
The West Suburban Special Recreation Association is a part of your local park district or village recreation program. We provide recreation programs for adults and children who have a physical impairment, a mental disability, or any other type of disability. Your park district or village governs the operation of the Association. The partner districts and villages and their representative to our Board of Directors are listed below:
BOARD OF DIRECTORSBerwyn Park District ............................................................ Jeff JandaClyde Park District ............................................................. Alex RuedaVillage of Elmwood Park .......................................... John LannefeldPark District of Forest Park .............................................. Larry PiekarzPark District of Franklin Park ............................... Joseph D. ModrichVillage of Harwood Heights .................................Michael GadzinskiHawthorne Park District ............................................. Dennis RaleighNorridge Park District ................................................... Mark DeSalvoNorth Berwyn Park District ...................................... Joseph C. VallezPark District of Oak Park ...............................................Marty BraccoRiver Forest Park District .................................................. Mike Sletten
BOARD MEETINGSThe Board of Directors of the Association meets on the second Tuesday of the month 8 times per year at 7:00 PM. Call the office at 847.455.2100 for the location of the meetings. The public is invited to attend.
REGISTRATION UPDATEALL WINTER 2011 REGISTRATIONS TAKEN ON AFIRST-COME, FIRST-SERVED BASIS AFTER ..........December 13, 2010WINTER PHONE-IN REGISTRATION BEGINS.......December 13, 2010WINTER REGISTRATION ENDS.................................. January 12, 2011SPRING 2011 BROCHURES DISTRIBUTED.....................February, 2011
WSSRA STAFFSandra Gbur .......................236 .................................................Executive Director ............................................................... [email protected] Birko ....................226 ...................................... Superintendent of Recreation .............................................. [email protected] A. Foster ...................238 ..............................Superintendent of Safety & Operations ..................................................bobf@wssra.netMaryellen Bilek ....................228 ............................................... Outreach Specialist .......................................................maryellenb@wssra.netSherry Scouffas ....................225 ............................................... Outreach Specialist ................................................................sherrys@wssra.netGretchen Dennis .................219 ................................................ Inclusion Manager .........................................................gretchend@wssra.netMatt Barber ..........................235 ........................................ Human Resource Manager ......................................................... [email protected] Krawiec .....................231 ................................................ Program Manager ................................................................dawnk@wssra.netAhren Hoffman ....................234 ............................................Recreation Coordinator ...........................................................ahrenh@wssra.netAnnie Lhotka ........................230 ............................................Recreation Coordinator .............................................................anniel@wssra.netApril Ryan .............................240 .............................................. Recreation Specialist ..................................................................aprilr@wssra.netAmy Mepham .....................232 .............................................. Recreation Specialist ...............................................................amym@wssra.netKristy Dacanay ....................224 ................................................... Lekotek Leader .....................................................................kristyd@wssra.netLisa Gershak ........................221 .................................................Finance Manager .....................................................................lisag@wssra.netNoelia Hernandez ...............222 ..........................................................Registrar ............................................................................nolyh@wssra.netAileen Maldonado .............220 ............................................ Administrative Assistant ..........................................................aileenm@wssra.netLuz Rocha-Serrano .............245 ..................................................... WSSRA DriverLarry Feldt .............................245 ..................................................... WSSRA DriverJoe Wolfe ..............................245 ..................................................... WSSRA DriverMike Zych .............................245 ..................................................... WSSRA Driver
Winter 2011 Photo by David Kindler
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Programs at a Glance
CHILDREN 7-8 SCHOOL AGE 9-19 SUMMER DAY CAMP 15-18 SPORTS AND FITNESS 20-23 TEENS & YOUNG ADULTS 20-26 ADULTS 22 YEARS & OLDER 20-26 OLDER ADULTS 27-28 SPECIAL EVENTS 28
KEY TO ABBREVIATIONSADD: Attention Deficit Disorder
ADHD: Attention Deificit Hyperactivity Disorder
ALZ: Alzheimer’s
AUT: Autism
BD: Behavior Disorder
DD: Developmental Disability
EC: Early Childhood
HI: Hearing Impairment
LD: Learning Disability
MI: Mental Impairment
MLH: Mental Health
PI: Physical Impairment
SL: Speech & Language Delay
VI: Visual Impairment
BEAT THE PHONE RUSHFAX your registration today at 847.455.2157. Contact your local Park District for use of their FAX machine for your WSSRA registration.
Por favor llame a la oficina de WSSRA. Deje un mensaje en extension 222. Noelia Hernandez les respondera lo mas pronto posible. Tel: 847.455.2100 ext. 222.
INDIVIDUALS WHO HAVE A HEARING IMPAIRMENT OR COMMUNICATION DISORDER CALL 847.455.2100 TO UTILIZE OUR TDD!
WWW.WSSRA.NETCheck out the WSSRA web site for up to date program information. E-Mail your comments to us: [email protected]
FOLLOW US ON:
WSSRA’s WINTER program session is 8 weeks in length for most programs. WINTER programs begin January 31, 2011. For exact times and days, please consult each program description in this brochure.
$PPT WSSRA
Transportation
Transportation by Pick Up Point
Bring Extra Money to Program
Cover photo by Antonio Perez
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WSSRF’s BEARS PARTY: A BIG WIN FOR DAY CAMP! The WSSRF’s Bears vs. Bills Party was a huge success raising $5,459 to fund additional summer day camp staff. Special thanks to John Mullins for chairing this winning event.
WSSRA and WSSRF would like to acknowledge the following generous donors:Amanda BarberNoemi DiazCasa De Puros, Forest ParkGood Heart, Work Smart FoundationMarion Street Cheese Market, Oak ParkJohn and Norine MullinsJim & Margaret O’RourkeTony and Rocio PerezScouffas Family
WSSRF is very grateful to the Good Heart, Work Smart Foundation for their $3,000 donation!
BERWYNHavlicek School6401 15th St. .......................................708.795.2450Jefferson School7035 16th St. .......................................708.795.2454Liberty Recreation Center6445 W. 27th Pl ...................................708.795.2891Morton West High School 2400 Home .........................................708.222.5700North Berwyn Park District16th & Wesley ....................................708.749.4900PAV Berwyn YMCA2947 S. Oak Park Ave .......................708.749.0606Proksa Park3001 Wisconsin...................................708.795.2892Striker Lanes6728 16th St. .......................................708.484.7831
CICEROCicero Community Center 2250 49th Ave ....................................708.477.6308Cicero West School4937 W. 23rd St. .................................708.780.4487Clyde Park District Stadium1909 S. Laramie .................................708.652.3545Columbus West School 5425 W. 31st........................................708.780.4482Hawthorne Park District5200 W. 29th Pl ...................................708.863.6511Morton East High School2423 S. Austin Blvd .............................708.222.5264Roosevelt School1500 S. 50th Ave ................................708.652.7833Unity East School 2115 S. 54th Ave ................................708.863.8229Town Hall Bowl5025 25th St. .......................................708.863.0300
ELMWOOD PARKElmwood Park Recreation Center2 Conti Parkway ................................708.452.3935Elmwood Park Family Aquatic Center2 Conti Pkwy. .....................................708.452.3935Warren Park1225 S 60th Ct ....................................708.863.2220
FOREST PARKCircle Bowl7244 Circle ..........................................708.366.2810Field Stevenson School925 Beloit ............................................708.366.5703Park District of Forest Park7501 Harrison ......................................708.366.7500Forest Park Middle School925 Beloit ............................................708.366.5703
FRANKLIN PARKCenter at North Park10040 Addison ...................................847.678.4021Enger School10401 W Grand ................................847.455.5299Franklin Park Community Center9560 Franklin ......................................847.455.2852Franklin Park Ice Arena9711 Waveland ................................847.671.4755Karate for Kids10125 W. Grand ...............................847.349.5425 WSSRA Office2915 Maple St. ..................................847.455.2100
HARWOOD HEIGHTSHarwood Heights Village Hall7300 Wilson ........................................708.867.7200
NORRIDGEGiles School4251 N. Oriole ....................................708.453.4847Norridge Park District4631 N. Overhill .................................708.457.1244
OAK PARKAscension Church601 Van Buren ...................................708.848.2703Barrie Recreation CenterGarfield & Lombard .........................708.383.6905Carroll Recreation Center1125 S. Kenilworth .............................708.383.6906Field Recreation Center935 Woodbine Ave. .........................708.383.6907Fox Recreation CenterOak Park & Jackson .........................708.383.6908Irving School1125 S. Cuyler Ave ............................708.524.3090Longfellow Recreation CenterRidgeland & Adams .........................708.383.6909Longfellow School610 Highland ......................................708.524.3060Mann School921 N. Kenilworth ...............................708.524.3084Oak Park River Forest High School Lake & Scoville ..................................708.383.0700Whittier School715 N. Harvey ...................................708.524.3080
RIVER FORESTConcordia University Pool7400 Augusta .....................................708.209.3118
See www.wssra.net for directions.
Program Locations
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NEW MEMBERSThe WSSRF welcomes new members. Please consider joining! No one on the Foundation is asked to do more than they can handle, yet by working together, WSSRF raises $20,000 each year to support WSSRA programs. At each meeting, Foundation members have the opportunity to give input and ideas about program offerings. So come join the fun and help WSSRF improve and expand programs for persons of all ages with disabiltiies. Call Sherry Scouffas at 847.455.2100 ext. 225 to learn more.
The WSSRF needs you!
Tania AndradeBrittney AngileriRebecca BaimanDanette BakerDavid BanasJoAnn BarberNick BarnesJon BasinskiHalina BednarzKaren BellafioreAnthony BeckerElizabeth BermanLakesha BeyAlex BrunetMary BullockJohn BuonicontiKristen CalvertKarina CarreraAngie ColemanKatie ColemanKristen CornaJason CurleyHeather DeLaGarzaDan DeRosaBertha DiazSam DiCaroNicole Di PaolaShelia DonoghueMarge DruskaGeoff EssexLauren FarmerBeverly FeltonSarah Forte
Megan FosterLogan FrankSandra GarciaCarissa GottliebNichole GunnApril GuzmanKurt GrahnkeErin GrimesTim HanleyElliot HenryMayra HernandezRyan HornNina IannottaPatty IannottaTrisha IannottaKatherine JohnsonDina JonesMary JonesJamee KennyNancy KnudsonMegan KopczDave KordeshTim KordeshKelli KruegerSarah KuhrApril KusDaria LatochaAndrew LeeAshley LenardiCarlos MarroquinAmelia MartinezKris MazzaTeegan McFeely
Kaitlin McNultyMike MeyerJenny MezaNatalie MezaJames NakatsukaJoanie NobleAnel OlivaresKaren OnischukDanielle PapeAnisa PashajAllison PorschakinJessica QuartararoAmanda RaimondiAnne RalenkotterMaria RamirezBryan RascheJill RecordLorie ReyesEmily RichardsonJunior RodriguezTom RyanJeff SchaeferNicole SchraubJeanne SimonsMary Kate SkalitzkyGisela SolisMaurissa StorkIrene TalaveraEric ThomasIgnacio TorresJohn VicarsMike VinciAmanda Ziupsnys
WSSRA is looking for energetic & caring staff to assist in recreation programs for individuals with disabilities. You will:• Meet new people while participating in fun recreation activities. • Enjoy personal growth. • Have a flexible schedule (morning, afternoon, evening & weekend hours available). • Gain leadership skills. • Enhance self-esteem by being part of a team that brings out the best in everyone.
For more information call 847.455.2100 or visit www.wssra.net.
Thank Yous
THANK YOU VOLUNTEERS & STAFFWe thank all of WSSRA’s fall volunteers & staff. Programs could not run without them!
Calendar of Events - Winter 2011
SPECIA
L EVENTS
MO
NDA
YTUESDA
YW
EDNESDA
YTHURSDA
YFRIDA
YSA
TURDAY
WINTER ESCAPE
WEEKEND
January 14, 15, 16, 2011W
hite Pines Ranch Oregon
WSSRA GOLF
PARTEEBensenville G
olf Dom
eSaturd
ay, February 5, 2011
ISO DISTRICT BBTOURNAM
ENTSaturd
ay, Jan. 22, 2011 Location: TBA
ITRS TEAMTOURNAM
ENTSund
ay February 13, 2011 Location: TBA
WDSRA SW
IM M
EETSaturd
ay February 5 , 201112:00pm
-5:30pm
(1:00-4:00pm m
eet time)
West C
hicago High School
FAMILY W
INTER FESTSund
ay February 6, 20111:00 – 3:00pm
Barrie Recreation C
enter,O
ak Park
ISO DISTRICTAQUATICS M
EETW
ednesd
ay, March 2, 2011
Location: TBA
FLAP JACK BUNNY HOPSaturd
ay April 9, 2011
8:30-10:30amA
scension Church Pine Room
, O
ak Park
SEASPAR BOWL
TOURNAMENT
Sunday, A
pril 16, 2011N
oon – 4:30pmW
illowbrook Lanes
HEALTHY START10:00 – 11:30amFranklin Park C
omm
unity Center
DANCE MANIA
2:45 – 4:00pmC
olumbus W
est School, Cicero
WALK-N-DINE
9:30am – 12:30pm
Weekly location varies
YOGA
10:00 – 11:30amV
illage of Harwood
HeightsSession 1: Jan. 4 – Feb. 8, 2011Session 2: Feb. 15 – M
ar. 22, 2011
WILD CARD
WEDNESDAYS
9:30am – 12:30pm
PDFRP
DOWNHILL SKIER
3:30 – 8:30pmFour-lakes, LisleJanuary 5, 12, 19, 2011M
ake Up Date: January 26, 2011
Ski Lesson: 4:30 – 5:30pm
BERWYN SPORTS
GALORE3:00-4:30pmHavlicek School, Berw
yn
FUN FACTORY11:45 – 1:15Franklin Park C
omm
unity Center
WSSRA’s M
IX IT UP
3:15 – 4:30pm
Enger School
FUN FACTORY3:45 – 5:15pmFranklin Park C
omm
unity Center
CITY TOURS + TOWERS
10:00 – 2:00pmN
orth Berwyn Park D
istrict, Berw
yn
SENSATIONALSATURDAYS9:00 – 11:30amN
orridge Park D
istrict
SATURDAY FUN CLUB9:00 – 11:30amC
arroll Center, O
ak Park
OUTDOOR ADVENTURES9:30am
– 12:30pmPark D
istrict of Forest Park Bldg #4
BOCCIA GS10:00 – noonLiberty C
enter
SPLASHTASTICFAM
ILY SWIM
10:30 – noon, Concord
ia pool
TUMBLING INTO FUN
3:15 – 4:30pm
Jefferson School, Berwyn
WE’VE GOT TALENT
2:45 – 4:15pmM
orton West High School
TACTILIANS
3:15 – 4:45pmIrving School, O
ak Park
YOGA FOR ALL
3:30 – 4:10pmBarrie Rec. C
tr
EXPLORE THE ARTS
4:15 – 5:00pmBarrie Rec. C
tr
GOAL!2:10-4:00pm
Unity School East, D
oor #14
WEDNESDAY HI
EXPLORERS CLUB 3:30 - 6:00pmHaw
thorne Park District
WITNER ZEBRA SPORTS
4 – 8 yrs, 6:30 – 7:15pmIrving School, O
ak Park
SALTA JUMP!
2:50 – 4:00pmW
arren Park School, Cicero
STRIKE-OUT BOWLERS
3:00 – 4:30pmTow
n Hall Bowl
WEIRD SCIENCE
2:50 – 4:00pmC
icero West
WINTER/SPRING SPECIAL
OLYMPIC TRAINING &
SPORTS3:45 – 5:15pm
Location: TBA
CREATIVE MOVEM
ENT &TUM
BLINGN
orridge Park D
istrictPietrini &
EP students
3:45 – 4:45pmScott stud
ents 3:45 – 4:45pm
SWIM
LESSONS
3:45 – 6:00pm3:45 – 4:15pm4:20 – 4:50pm4:55 – 5:25pm5:30 – 6:00pmPA
V YM
CA
, Berwyn
JR. BULLSN
oon – 2:00pmN
EDSRA
, Ad
dison
Super Saturdays12:15 – 2:45pmC
arroll Recreation Center,
Oak Park
Saturday Bowling League
1:00 – 3:00pmC
ircle Bowling Lanes, Forest Park
SWIM
LESSONS 6:25-6:55amO
PRFHS-Girl’s Pool
ADVANCED SWIM
MERS
6:15 – 6:55amO
PRFHS-Girl’s Pool
STINGRAY SWIM
TEAM
7:00 -8:10pm
(7:05 - 8:10-pool time)
OPRFHS-G
irls Pool
AQUA ATHLETICS
8:15 – 9:00O
PRFHS – Girls pool
BOBCATS PRE-SEASONBASKETBALL7:00 – 8:30pmUnity
WEEKLY W
ORKOUT
7:00-8:15pmPark D
istrict of Franklin Park
TAE KWON DO
7:15 – 8:00pm
Karate for Kids, Franklin Park
SWIM
LESSONSA
ll ages5:00 – 5:35 5:45 – 6:20 C
oncordia University pool
SO TRACK & FIELD CLINIC
7:15 – 8:30pmC
icero Com
munity C
enter
SWIM
LESSONS6:30 – 7:10 A
ll agesM
orton East High School
reDESIGN4 w
eeks7:00-8:30pmElm
wood
Park Rec Center
iDANCE4 w
eeks7:00-8:30pmElm
wood
Park Rec Center
Winner Takes All
6:00-8:30pmW
SSRA O
ffice
Food Critics
7:00 – 10:00pmBarrie C
enter Oak Park
Friday Show tim
e
Barrie Center, O
ak Park
Hot Shots Carroll City Slickers Barrie6:00 – 9:00pm
varies weekly
Socialites_ Carroll M
oonlighters Barrie6:00 – 9:00pm
varies weekly
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LEKOTEKALL ABILITIESWSSRA’s Lekotek is a toy lending library and resource for family play. Families meet for a one hour play sessions each month guided by a trained Lekotek leader. Families have the opportunity to borrow from our inventory of over 2,000 toys including adapted toys which makes play possible for all kids. Lekotek offers:
• Relaxing, guided play sessions. • Home loan of up to six toys monthly.• Opportunities to focus on the abilities of children.• Positive parent/child interactions that increase skills.• Self-esteem building.• Sibling play and fun.
Monthly play sessions take place at the WSSRA office or North Berwyn Park District. Call Kristy or Ahren at 847.455.2100 for details and to schedule your first play session.
Age: Birth to 6 YearsFee: $6.00 per visit (including toy check out)Registration Number: 100
TUMBLING INTO FUNALL ABILITIESDon’t miss this opportunity to have your child enjoy some fun with friends after school. Participants will have the opportunity to run, jump and tumble and enjoy music, games and activities.
Upon the conclusion of the program parents will pick-up their children at Jefferson school.
Age: 3 - 6 YearsDate: Mondays, January 31 – March 21, 2011(No program February 21)Time: 3:15-4:30 PMLocation: Jefferson School, BerwynFee: $14.50Registration Number: 114
FUN FACTORY ALL ABILITIESLASEC and Elmwood Park Early Childhood students can enjoy an extension of the school day by:• Enjoying music activities that will promote speech & language development.• Engaging in activities and games that help promote gross motor skills.• Participating in stimulating craft activities that help promote fine motor development.• Eating a healthy snack provided weekly.Transportation to the program may be available. Upon the conclusion of the program parents will pick-up their children at the Franklin Park Community Center.
Age: 3-7 YearsDate: Thursdays, February 3 – March 24, 2011Times: 118-01 11:45-1:15 PM 118-02 3:45-5:15 PMLocation: Franklin Park Community CenterFee: $3.10 each week ($24.80 / 8 week session)Pick Up Point Trans: $1.40 each week($11.20/8 week session)Registration Number: 118
CREATIVE MOVEMENTALL ABILITIES - ELMWOOD PARK AND LASEC STUDENTS ONLYDon’t miss this opportunity to have your child enjoy some fun with friends after school. Participants will have the opportunity to run, jump and tumble to music, games and activities.
This program is offered to Elmwood Park & LASEC students only. The program will begin immediately following your child’s school day. Transportation is available to the program only. Upon the conclusion of the program parents will pick-up their children at the Norridge Park District.
Age: 3 - 7 YearsDate: Fridays, February 4 – March 25, 2011Time: 3:45-4:45 PMLocation: Norridge Park District, Green RoomFee: $16.60 Trans to Program: $11.20Registration Number: 111
Children
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SATURDAY FUN CLUB
Age: 3-6 YearsTime: 9:00-11:30 AMLocation: Carroll Recreation CenterFee: $10.40 week / $83.20 season
SENSATIONAL SATURDAYS
Age: 3-11 YearsTime: 9:00-11:30 AMLocation: Norridge Park District Fee: $10.40 week / $83.20 season
SUPER SATURDAYS
Age: 7-11 YearsTime: 12:15-2:45 PMLocation: Carroll Recreation CenterFee: $10.40 week / $83.20 season
Children
Date: SATURDAY FUN CLUB:February 5 .......................................104-01February 12 ..................................... 104-02February 19 .....................................104-03February 26 .....................................104-04March 5 ...........................................104-05March 12 .........................................104-06March 19 .........................................104-07March 26 .........................................104-08
SENSATIONAL SATURDAYS:......................................................................105-01......................................................................105-02......................................................................105-03......................................................................105-04......................................................................105-05......................................................................105-06......................................................................105-07......................................................................105-08
SUPER SATURDAYS:................................................................. 106-01................................................................. 106-02................................................................. 106-03................................................................. 106-04................................................................. 106-05................................................................. 106-06................................................................. 106-07................................................................. 106-08
ALL ABILITIESParticipants will enjoy Saturdays filled with music, games, crafts and much more. Register for one or all 8 weeks. An activity schedule will be sent the first week of program. Dress for indoor & outdoor play.Date: Saturdays, February 5 – March 26, 2011
SPLASHTASTIC FAMILY SWIM
ATTENTION! MOMS, DADS, SIBLINGS- GRAB YOUR SWIMSUITS AND TOWELS!We are very excited to introduce WSSRA’s Family Swim Series this season!
Come out and enjoy swimming as a whole family. One adult (18 years +) per 2 children must accompany them in the pool.• Saturday January 22 10:30-12:00• Saturday February 19 10:30-12:00• Saturday March 19 10:30-12:00• Saturday April 16 10:30-12:00
Come to 1, 2, 3 or all Saturday Family Swim’s and join us in a splash-tastic time in the water! This is a great opportunity for water interaction and family fun!Fee: $10 per family of 4 ($2 @additional person)Location: Concordia University (pool is not accessible)Registration Number: 193
Photo by David Kindler
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SWIM LESSONSALL ABILITIESWSSRA Swim Lessons are based on a Skill Development program through the American Red Cross. All skills will be taught in a progression. Bring suit and towel. Parents are responsible for changing child before and after lesson. Participants are limited to one half hour lesson per season. Lessons are designed to be appropriate for specific age groups as well as skill level.
PLEASE NOTE: ANYONE WITH POSSIBLE INCONTINENCE MUST WEAR PROTECTIVE PANTS UNDERNEATH THEIR SWIMSUITS. This is for everyone’s health & safety. If your child is wearing a swim diaper, the public health code requires them to wear rubber pants in addition to the diaper. Any problems in this area with your child could risk your child’s ability to participate in this program. If you have any questions, please contact us at 847.455.2100. Thank you for your attention and support. (Note: Concordia University Pool and Morton East High School are not accessible to persons who are non-ambulatory or use a wheelchair).
Age: 3 Years & Older, Preschoolers are welcome!
REGISTRATION NUMBER DAY TIME DATES LOCATION FEE
151-01 Mondays 6:15-6:55 PM January 31 – March 21(No program Feb. 21, March 7)
OPRFHS(Facility Pending)
$30.75(6 weeks)
Age Advanced swimmers only - Must swim 1 length of pool151-02 Mondays 6:25-6:55 PM January 31 – March 21
(No program Feb. 21, March 7)OPRFHS(Facility Pending)
$26.25(6 weeks)
Age All Ages151-03 Wednesdays 5:00-5:35 PM February 2 – March 23 Concordia University
(Not accessible)$33.00(8 weeks)
Age 0-6 Years151-04 Wednesdays 5:45-6:20 PM February 2 – March 23 Concordia University
(Not accessible)$33.00(8 weeks)
Age 7 Years & Up151-05 Thursdays 6:30-7:10 PM February 3 – March 24 Morton East HS
(Not accessible)$32.60(8 weeks)
Age All Ages151-06 Fridays 3:45-4:15 PM February 4 – March 25 PAV YMCA $30.00
(8 weeks)Age 6 yrs & under151-07 Fridays 4:20-4:50 PM February 4 – March 25 PAV YMCA $30.00
(8 weeks)Age All Ages 151-08 Fridays 4:55-5:25 PM February 4 – March 25 PAV YMCA $30.00
(8 weeks)Age 7 yrs & older151-09 Fridays 5:30-6:00 PM February 4 – March 25 PAV YMCA $30.00
(8 weeks)Age 6 yrs & Under
School-Aged
10 WSSRA.NET
!SALTA:JUMP!LD, BD!Saltamos! Everybody jump! Jump, dance, run, and play along to music and games to channel our energy into fun times. Participants will also enjoy a light snack.
Students will be bussed home by District 99 at 4:00 PM. Participation numbers are limited. Call for registration information.
Age: 6-10 YearsLocation: Warren Park School, Cicero
WINTER SESSIONTime: 2:50-4:00 PMDate: Wednesdays, February 2 - Mar 23, 2011Fee: $16.10Registration Number: 126
SPRING SESSIONTime: 2:50-4:00 PMDate: Wednesdays, April 13 - May 18, 2011 Fee: $12.10Registration Number: 226
YOGA FOR ALLALL ABILITIESParticipants will be introduced to simple yoga positions, meditative practice & stretching exercises in a fun, playful environment. The program’s focus will be on:• Body control• Gaining flexibility• Gaining strength
Age: 6-12 YearsDate: Tuesdays, February 1 – March 22, 2011Time: 3:30-4:10 PMLocation: Barrie Recreation Center, Oak ParkFee: $20.20Transportation to program only: $24.20Registration Number: 109
SIGN UP FOR EXPLORE THE ARTS TOO!
EXPLORE THE ARTSALL ABILITIESGrab a brush, sponge or even use your fingers to paint, build a pot with clay, and discover your creative abilities. Add some music and we’ll be dancing. There’s no limit to the elements we will explore!
Age: 3-11 YearsDate: Tuesdays, February 1 – March 22, 2011Time: 4:15-5:00 PM Location: Barrie Recreation Center, Oak ParkFee: $20.20Transportation home only: $24.20Registration Number: 107
TAE KWON DO ALL ABILITIESThis introductory class is designed to captivate the interest of our youngest student. Karate for Kids teaches the American Tae Kwon Do Association curriculum. It is based on the concepts of positive mental attitude and high goal setting. Building blocks for this system include the following:
•Goals •Self-control •Courtesy •Integrity •Friendship •Confidence •Self-awareness •Self-Esteem •Perseverance •Self Improvement •Respect •Dedication
A uniform is required for all new students. (Additional one time fee of $40 for uniform) Age: 9-14 YearsDate: Tuesdays, February 1 – March 22, 2011Time: 7:15-8:00pmLocation: Karate for Kids 10125 W. Grand Avenue, Franklin ParkPick up Point: North Berwyn Park DistrictDrop off time: 6:30 PM Pick up time: 8:30 PMFee: $60.00 Pick up Point Trans: $22.00Registration Number: 113
“I like to swim because it’s fun- I can go underwater and sit on the bottom.”
Enrique Armenta
School-Aged
11 WSSRA.NET
School-AgedTACTILIANS
ALL ABILITIESJumping, crawling, smelling, touching & exploring is what we’ll do. Each week we will have sensory stations set up for your child to explore & enjoy.
Age: 3-10 YearsDate: Mondays, January 31 – March 21, 2011 (No Program Feb. 21 & March 7)Time: 3:15-4:45 PMLocation: Irving School, Oak ParkFee: $32.40 Trans: $36.30Registration Number: 137
CREATIVE MOVEMENT ALL ABILITIES - ELMWOOD PARK AND LASEC STUDENTS ONLYDon’t miss this opportunity to have your child enjoy some fun with friends after school. Participants will have the opportunity to run, jump and tumble to music, games and activities.
The program will begin immediately following your child’s school day. Transportation is available to the program only. Upon the conclusion of the program parents will pick-up their children at the Norridge Park District.
Age: 3 - 7 YearsDate: Fridays, February 4 – March 25, 2011Time: 3:45-4:45 PMLocation: Norridge Park District, Green RoomFee: $16.60 Trans to Program: $11.20Registration Number: 111
WE’VE GOT TALENT!ALL ABILITIESThe WSSRA talent search has begun! Come join us for some fun. We’ll be learning new dance moves, enjoying karaoke & creating through improvisation. A light snack will be provided. Door to door transportation available home only.
Age: 11-22 YearsLocation: Morton West High School
WINTER SESSIONTime: 2:45-4:15 PMDate: Mondays, Jan 31 - Mar 21, 2011(No prog Feb 21, Mar 7)Fee: $12.10 Trans: $12.10Registration Number: 116
SPRING SESSIONTime: 2:45-4:15 PMDate: Mondays, April 11 - May 16, 2011Fee: $12.10 Trans: $12.10Registration Number: 216
DANCE MANIAColumbus West Students Only - MI, AUT, DDCome join us after a long day at school as we get up and DANCE! We’ll learn new moves and play games. Come prepared for crafts & dancing. A light snack will be provided. This program is partially funded by a grant from the Town of Cicero. Students will be transported home by District 99 at 4:00 PM
Age: 7-14 YearsLocation: Columbus West School, Cicero
WINTER SESSIONTime: 2:45-4:00 PMDate: Mondays, Jan 31 - Mar 21, 2011(No prog Feb 21, Mar 7)Fee: $12.10Registration Number: 120
SPRING SESSIONTime: 2:45-4:00 PMDate: April 11 - May 16, 2011Fee: $12.10Registration Number: 220
The purpose of this phone number is to allow access to WSSRA for emergencies only during non-office hours.
1. The phone may be called Monday through Friday, from 5:00 PM to 11:00 PM, Saturday, 7:00 AM to 11:00 PM when programs are in session only.
2. Leave a message with your phone number at 847.833.9611 and a WSSRA staff will return your call.
3. The emergency phone should not be a substitute for calling the office for non-emergency questions, such as pick up times.
EMERGENCYPHONE
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GOAL! LD, BD, VI, PIPut your fitness skills to the test. Learn how to:• Work as a team • Develop & refine a variety of sport skills• Develop a fitness routine you can continue on your ownWSSRA will bus students to Unity. Transportation home is available.
Age: 7-22 Years Location: Unity East, Cicero
WINTER SESSIONTime: 2:10-4:00 PM Date: Wednesdays, Feb 2 - Mar 23, 2011(No prog Feb 9, Mar 16)Fee: $12.10 Trans: $12.10Registration Number: 119
SPRING SESSIONTime: 2:10-4:00 PMDate: Apr 13 - May 11, 2011 (No prog Apr 27, May 18) Fee: $12.10 Trans: $12.10Registration Number: 219
WEIRD SCIENCETMI, AUT, MI, DDExplore all things gooey, icky and fun! Students will be transported home by Cicero School District #99 at the end of the program. If you plan to pick up your child, please notify WSSRA staff in advance.
Age: 7-22 YearsLocation: Cicero West, Cicero
WINTER SESSIONTime: 2:50-4:00 PMDate: Thursdays, Feb 3 - Mar 24, 2011 Fee: $16.20Registration Number: 123 SPRING SESSIONTime: 2:50-4:00 PMDate: Thursdays, Apr 14 - May 19, 2011 Fee: $12.10Registration Number: 223
STRIKE OUT BOWLERSALL ABILITIES - FOR CICERO STUDENTS ONLYEnjoy an afternoon of bowling fun! Participants will:• Be taught bowling skills in a progression • Learn safe and correct techniques• Learn basic scoringBumpers and adaptive equipment will be available if needed. Transportation to the program provided by District #99. Transportation home provided by the Town of Cicero Paratransit Program.
Age: 7-22 YearsLocation: Town Hall Bowl, Cicero
WINTER SESSIONTime: 3:00-4:30 PM Date: Thursdays, Feb 3 - Mar 24, 2011 Fee: $40.00 Registration Number: 127
SPRING SESSIONTime: 3:00-4:30 PMDate: Thursdays, Apr 14 - May 19, 2011Fee: $30.00Registration Number: 227
SPECIAL OLYMPIC TRAINING & SPORTS
MI, AUT, MH, DDEnjoy an afternoon of fitness fun and Special Olympic Track & Field Training. Participants will:• Practice for softball throw, short running and long jump events.• Stretch & do warm up exercises.Participants will automatically be registered for SPRING Games on Sunday, May 1, 2011. All participants must have a current Special Olympic medical on file by March 1, 2011 to participate in SPRING Games. See page 22 for form.
Age: 7-22 YearsDate: Thursdays, Feb 3 - Mar 24, 2011Time: 3:45-5:15 PMLocation: PAV YMCA, BerwynFee: $43.20 Trans: $48.40Registration Number: 132
“I liked when we made the ‘goobeleck’ in Weird Science.”
LatrellBirdow
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BERWYN SPORTS GALORELD, BD, VI, PIPut your fitness skills to the test. Learn to:• Work as a team • Refine your sports skills• Develop a fitness routine you can continue on your ownParticipants can develop their self-confidence and decision making skills. Transportation home is available.
Age: 7-14 YearsLocation: Havlicek School, Berwyn
WINTER SESSIONTime: 3:00-4:30 PM Date: Wednesdays, Feb 2 - Mar 23, 2011Fee: $8.10 Trans: $8.10Registration Number:115
SPRING SESSIONTime: 3:00-4:30 PMDate: Wednesdays, April 13 - May 11, 2011Fee: $8.10 Trans: $8.10Registration Number: 215
DOWNHILL SKIERALL ABILITIES & SIBLINGS TOO! Learn to downhill ski or polish your skills through three, one-hour group lessons by a specially trained instructor from Four Lakes Village in Lisle, Illinois. Following the lessons each week, participants will have approximately two hours of free skiing with the careful supervision of WSSRA staff. Transportation provided from school to ski resort and return home.
Age: 8 Years & OlderDate: Wednesdays, Jan 5, 12, 19, 2011(Make-up date Jan. 26)Time: 3:30-7:30 PM, (Time includes drive time)Location: Four Lakes Village, LisleFee: $123.00 Trans: $18.25Registration Number: 128
WINTER ZEBRA SPORTSALL ABILITIESCome join WSSRA’s rookie athletes, the “Zebras”, as they develop athletic skills and learn a variety of games & sports. Skills to be developed during this program are:• Eye/hand coordination • Eye/foot coordination• Running • Ball handling• Fielding • Learning to work as a team
Come join the fun!
Age: 4-8 YearsDate: Wednesdays, Feb 9 – Mar 23, 2011Time: 6:30-7:15 PM Location: Irving School, Oak ParkFee: $19.00Registration Number: 135
WEDNESDAY EXPLORER’S CLUBHI, DEAF, HARD OF HEARINGJoin us for an afternoon of fun & games. Participants will have opportunities to:• Be challenged in team building activities• Learn team rules to games and about good sportsmanship• Enjoy expressing themselves through drama and art activities.This program is partially funded by a Town of Cicero grant.
Age: 7-22 YearsLocation: Hawthorne Park District, Cicero
WINTER SESSIONTime: 3:30-6:00 PMDate: Wednesdays, Feb 2 - Mar 23, 2011 (No program Feb 9, Mar 16)Fee: $12.10 Registration Number:125
SPRING SESSION Time: 3:30-6:00 PMDate: Wednesdays, Apr 13 - May 11, 2011 (No prog Apr 27 ) Fee: $8.10Registration Number: 225
“I like to help Amy lead the yoga poses at ‘Yoga for All’. I always pick the Tarzan pose from the envelope!”
JulianDunn
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OPPORTUNITIES!WSSRA is teaming up with NEDSRA to offer adapted sports opportunities for anyone with a physical disability. WSSRA will provide staffing for these programs but you must provide your own transportation to and from the program. If you have questions call WSSRA’s April Ryan at 847.455.2100 ext 240 or email [email protected].
These programs are open to anyone with a physical disability who is ambulatory or uses a wheelchair. All players must play from a sports chair for games and practices. WSSRA has sports chairs available for use. Check out these exciting opportunities:
JR BULLS PREPARATORYWHEELCHAIR BASKETBALL
Basketball season is back and the Jr. Bulls Prep team is the perfect answer for newcomers to this sport. Practices will review basic skills, learn the rules of the game and develop team play. Games are played throughout the Midwest. Fee will be pro-rated for new athletes.
Age: 12 Years & UnderDate: Saturdays, Jan 8 - Mar 26, 2011 Time: Noon - 2:00 PMLocation: NEDSRA Office, 1770 W Centennial Place, AddisonFee: $300.00 (Includes tournaments) Payment plan available.Registration Number: 153
BOCCIAPIJoin the Paralymic Boccia experience! Individuals with physical challenges are given the opportunity to try this new sporting experience and compete in the Paralympic arena at regional games, tournaments and even state competitions. Come out and meet new friends while challenging yourself. This program is partially funded by Thumbuddy Special. Limited transportation is available - Call for details.
Age: 6-22 YearsDate: Saturdays, Feb 5 – Mar 26, 2011Time: 10:00 AM - 12:00 PMLocation: varies weeklyFee: $18.00 Trans: $48.40Registration Number: 150
JR BULLS JVWHEELCHAIR BASKETBALL
JR Bulls JV – is for the seasoned player. The program begins with practices and then play games throughout the Midwest.Fee will be pro-rated for new athletes.
Age: 13 Years & OlderDate: Saturdays, Jan 8 - Mar 26, 2011 Time: Noon - 2:00 PMLocation: NEDSRA Office, 1770 W Centennial Place, AddisonFee: $300.00 (Includes tournaments) Payment plan available.Registration Number: 154
Adaptive Sports
“I love Super Saturdays because I get to spend the afternoon with cool kids.” Alex
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CAMP ACTIVITIES MAY INCLUDE:• Sports • Music • Field Trips • Swimming (Full Day Only)• Drama • Games • Arts & Crafts
WSSRA RESIDENTSServing residents of the Villages of Harwood Heights and Elmwood Park and the Park Districts of Berwyn, Clyde, Forest Park,Franklin Park, Hawthorne, Norridge, North Berwyn, Oak Park and River Forest.
CAMP DATESJune 20 – July 29, 2011 Monday through Friday.There is NO CAMP on Monday July 4, 2011
FULL-DAY CAMP (AGES 7-22)9:00AM – 3:00PM, Monday through FridayFull Day is not an option if your child attends summer school.
HALF-DAY CAMP (AGES 7-22)Noon – 3:00PM, Monday through Friday• You must indicate on your registration form if you will be
registering for the half-day option.• A limited number of half day spots are available and will be
filled according to the February lottery.• No adjusted registrations can be made for participants
attending summer school.
PRESCHOOL CAMP (AGES 3-6)Choose one:Morning Session: No swimming offered. .......... 9:00–11:45 AMAfternoon Session: No swimming offered. ........ 12:15–3:00 PM
CAMP LOCATIONSCamps may be held in Berwyn, Cicero, Forest Park or Oak Park. Camps will be assigned a location based on space needed and facilities available. You will be notified by mail as to your child’s camp location.
DAY CAMP FEESFull-Day Option:…………… ............................................ $468.00Half-Day/Preschool Option: ............................................ $234.00
TRANSPORTATION FEESOne-Way Transportation: ............................................... $211.50Round-Trip Transportation: ............................................ $423.00
TRANSPORTATIONDoor to door transportation for camp is available. You must sign up for transportation when you are completing your registration form. Limited transportation slots are available. Transportation fees will be added to your day camp registration. Transportation for camp is not provided for participants without a physical disability living within 4 blocks of the assigned camp site. Buses are not air-conditioned.
SCHOLARSHIPSIf you are unable to afford the fee for day camp, you may request a scholarship application from the WSSRA office or download the scholarship form from the WSSRA web site, www. wssra.net. All applications must be completed and returned by February 4, 2011 with your day camp registration form. You will be notified by mail if you will receive a scholarship and the amount of assistance granted. You must attend 20 days of camp in 2011 to be eligible to receive a scholarship in 2012. Any medical leave must be documented by a doctor.
REGISTRATION PROCEDURES1. Walk-in, mail-in, or fax (847.455.2157) your Day Camp
registration to WSSRA. You must call to confirm FAX was received.
2. You must return the Day Camp Registration fully completed, signed, and dated by February 4, 2011 at 5:00PM to be eligible for the lottery. Additionally, Scholarship Application forms must be in the office by this time as well.
3. The lottery will be drawn and scholarships will be awarded February 7-18, 2011.
4. Letter of acceptance into WSSRA Day Camp, information regarding scholarships awarded, and a payment schedule will be mailed out beginning February 23, 2011.
DAY CAMP PAYMENT SCHEDULE:1. First 1/3 of your total due March 25, 20112. Second 1/3 of total due April 21, 20113. Final payment due May 27, 2011. Anyone not completing their
payment by May 27 will risk losing their camp placement.4. Cancellations prior to May 28, 2010 will receive a refund less a
$10.00 processing fee. NO Refunds after May 27, 2011.
Questions, call WSSRA 847.455.2100
WSSRA’s 2011 Summer Day Camp is designed for participants ages 3-22, who have a disability and/or receive special education services. Your child must be 3 -22 years of age on the first day of camp to participate. Day camp registration is conducted by a lottery. All persons who meet the age & registration requirements will be entered into the lottery. If you are not selected in the lottery for day camp placement you will be placed on a waiting list according to the order you were drawnin the lottery. WSSRA offers different day camps according to age and ability groups. Camp provides age-appropriate recreational activities while achieving these goals:• To involve your child in fun recreational opportunities.• To improve your child’s motor skills and overall fitness.• To encourage an environment where your child can succeed and build self-esteem.• To help your child maintain & increase language and self-expression skills.
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LOTTERY DEADLINE:FEBRUARY 4, 2011
ACTIVIDADES DEL CAMPAMENTOLas actividades del Campamento pueden incluir:• Natación (Día Completo Solamente)• Deportes • Drama • MúsicaRESIDENTES WSSRASirviendo a los residentes de los Municipios de Harwood Heights y Elmwood Park y Distritos de Parques de Berwyn, Clyde, Forest Park, Franklin Park, Hawthorne, Norridge, North Berwyn, Oak Park y River Forest.FECHAS DE CAMPAMENTOJunio 20 – Julio 29, 2011 Lunes a Viernes.NO hay CAMPAMENTO el Lunes, 4 de JulioCAMPAMENTO DE DÍA-COMPLETO (EDADES 7-22)9:00AM – 3:00PM, Lunes a ViernesDía Completo es una opción si su niño no asiste a la escuelade verano.CAMPAMENTO DE MEDIO-DÍA (EDADES 7-22)Medio día – 3:00PM, Lunes a Viernes• Usted debe indicar en su forma de inscripción si usted esta
inscribiendo para la opción de medio-día.• Hay un número limitado de lugares para campamento de medio
día, y se llenarán de acuerdo de la lotería del Febrero.φ No se puede hacer ajustes de inscripción para los
participantes que asistan escuela de verano.CAMPAMENTO PREESCOLAR (EDADES 3-6)Escoja uno:Sesión de la Manana: No se ofrece natación...... 9:00–11:45AMSesión de la Tarde: No se ofrece natación. ....... 12:15–3:00 PMLOCALIDADES DE LOS CAMPAMENTOSLos campamentos pueden estar localizado en Berwyn, Cícero, Forest Park o Oak Park. Los participantes seran asignado una localizacion basada en edad y descapacidad. Se le notificarán por correo acerca de la localidad del campamento de su niño.TRANSPORTACIÓNTransportación de puerta-a-puerta para el campamento es disponible. Usted debe inscribirse para la transportación cuando complete su forma de inscripción. Lugares limitados de transportación están disponibles. El costo de transportación sera cargada junto con el inscripción de campamento de día. La transportación para el campamento no es proveída para participantes sin discapacidades físicas viviendo dentro de 4 cuadras del sitio del campamento asignado. Los autobuses no tienen aire-condicionado.
COSTO DE CAMPAMENTO DE DÍAOpción de Día-Completo ............................................ $468.00Opción de Medio-Día/Preescolar ............................... $234.00COSTO DE TRANSPORTACIÓNTransportación de Ida ................................................. $211.50Transportación de Ida y Vuelta .................................... $423.00BECASSi no puede pagar el costo de campamento de día, usted puede solicitar ayuda por beca de la oficina WSSRA o descargar la forma de beca de la pagina de internet de WSSRA, www. wssra.net. Es necesario completar y regresar la forma de beca antes de el 4 de febrero de 2011 con su forma de inscripción para el campamento de día. Usted será notificado por correo si usted recibirá una beca y el cantidad de ayuda que recibira. Es necesario asistir 20 días al campamento en 2011 para ser elegible para recibir una beca en el año 2012. Cualquier problema médica debe ser documentado por un médico.PROCEDIMIENTOS DE INSCRIPCIÓN1. Pase en persona, envíe, o mande por fax (847.455.2157) su
inscripción de Campamento de Día de WSSRA.2. Usted debe regresar la Registración de Campamento de Día
totalmente completa, firmada, y fechada antes de el 4 de Febrero de 2011 a la 5:00PM para ser elegible para la lotería. Adicionalmente, la forma de Aplicación de Becas necesita estar en la oficina junto con la forma de inscripcion
de Campamento3. La lotería sera procesado durante el tiempo de el 7 al 18 de
Febrero de 2011.4. Una carta de aceptación al Campamento de Día de WSSRA,
información referente a becas recibidas, y un calendario de pagos sera enviado por correo, comenzando el 23 de Febrero de 2011.
HORARIO DE PAGOS DEL CAMPAMENTO DE DÍA:1. La primera parte de su balance total es debido antes que el 25
de Marzo de 2011.2. La segunda parte de su balance total es debido antes que el
21 de Abril de 2011.3. El pago final se debe antes que el 27 de Mayo de 2011.
Cualquier persona que no termine de hacer sus pagos para el 27 de Mayo puede perder su lugar en el campamento
4. Cancelaciones antes de el 27 de Mayo de 2011 recibirán un reembolso menos $10.00 por costo de proceso. NO HAY REEMBOLSO después del 27 de Mayo de 2011.
Para Preguntas, llame a WSSRA al 847.455.2100
El Campamento de Verano de Día 2011 de WSSRA es diseñado para los participantes edades 3-22, quien tiene una descapacidad y/o recibe servicios de educación especial. Su niño debe tener de 3 -22 años de edad en el primer día de participación del campamento. Inscripción del Campamento de Día es conducido por medio de una lotería. Todas las personas que tienen la edad y requerimientos de inscripción entrarán en la lotería. Si usted no es seleccionado en la lotería para participar en campamento de día, usted será puesto en una lista de espera de acuerdo a la orden en la que quedó en el sorteo. WSSRA ofrece diferentes campamentos de día de acuerdo a la edad y los grupos de habilidad. El campamento provee actividades de recreación apropiada a la edad y al mismo tiempo logra estas metas:• Involucrar a su niño en oportunidades divertidas recreacionales.• Mejorar las habilidades motrices de su niño y aptitud en general.• Fomentar el ambiente en donde su niño pueda lograr y edificar su propia-estima.• Ayudar a mantener o ayudar a que su niño mantenga el incremente de su lenguaje y habilidades de expresión-propia.
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LOTTERY DEADLINE: February 4, 20112011 DAY CAMP REGISTRATIONFAX TO: 847.455.2157 MAIL TO: WSSRA, 2915 Maple Street, Franklin Park, IL 60131
SCHOLARSHIP REQUEST□ Request Scholarship□ Participates in free lunch program at school
CAMP OPTIONS□ 1/2 Day Option 7 & Up□ Full Day Option 7 & Up□ AM Preschool age 3 to 6□ PM Preschool age 3 to 6
TRANSPORTATION OPTIONScheck ONE□ Transport Self□ WSSRA Round Trip□ WSSRA Home Only□ WSSRA To Camp Only
DISABILITY□ Learning Disability□ Behavior Disability□ Hearing Impairment□ Developmental Disability□ Visual Impairment □ Physical Impairment□ Autism□ Other___________________
CAMPER’S T-SHIRT SIZE Child Size: □ 6-8 □ 10-12 □ 14-16Adult Size: □ S □ M □ L □ XL □ XX □ XXX
West Suburban Special Recreation Association WAIVER RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT (READ CAREFULLY)Please read this form carefully and be aware that in signing up and participating in West Suburban Special Recreation Association programs, you will be waiving and releasing all claims for injuries arising out of these programs that you or the named participant might sustain. The terms “I”, “me” and “my” also refer to parents or guardians as well as participants in programs. In registering for these programs, you are agreeing as follows:
As a participant in these programs, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I may sustain as a result of participating in any manner, in any and all activities connected with or associated with such activities and involve substantial risks of injury.
I agree to waive and relinquish any and all claims I may have as a result of participating in these programs against the West Suburban Special Recreation Association, any and all participating governmental units, any and all independent contractors, officers, agents, servants, and employees of the governmental bodies and independent contractors, and any and all other persons and entities of whatever nature that might be directly or indirectly liable for any injuries, that I might sustain while participating in these programs.
I do hereby fully release and discharge the West Suburban Special Recreation Association and the other related parties from any and all claims for injuries, damages or loss, which I may have or which may accrue to me on account of my participating in these programs.
I further agree to indemnify, hold harmless and defend, the West Suburban Special Recreation Association and any and all other parties from any and all claims resulting from injuries, damages and losses sustained by anyone, and arising out of, connected with or in any way associated with my conduct and the activities of these programs.
I further understand and agree that the terms such as “participation, and “activities”, referred to in this Agreement, include all exercises and physical movements of any nature while I am participating in these programs and further include the provision of, or failure to provide proper instructions or supervision, the use and adjustment of any and all machinery, equipment, and apparatus, and anything related to my use of the services, facilities, or premises, involved in these programs, and transportation to and from events.
I understand the nature of these programs for which I am registering, and have read and fully understand this Waiver, Release and Hold Harmless Agreement. I further understand that any advisement or warnings of particular risks of these programs that I subsequently receive will be incorporated by reference into and become a part of this Agreement.
In case of emergency, I give my permission for the participant to receive any first-aid, transportation or medical attention that may be required.
You must return this waiver and release of all claims by mail or fax. You may mail this release to 2915 Maple Street, Franklin Park, IL 60131 or send by fax to 847.455.2157. When forwarding by fax, it is mutually understood that the facsimile document shall substitute for and have the same legal effect as the original form.
PARENT/PARTICIPANT/GUARDIAN SIGNATURE ________________________________________________________________ Date___________________
participant’s name: _________________________________________ □male □female participant’s birthdate: ________ / ____/ ________parent/guardian 1: __________________________________________ parent/guardian 2: __________________________________________ address: __________________________________________________ city: _______________________________ zipcode: ______________home phone: ________________________________ park district/village: _______________________________________________________
e-mail address: work phone 1 (whose): ______________________________________ work phone 2 (whose): ______________________________________cell phone 1 (whose): ________________________________________ cell phone 2 (whose): _______________________________________emergency contact person (other than parent): __________________________________ emergency phone: ___________________________current school: ______________________________________ current teacher: ___________________________________________________doctor’s name: ____________________________________________________ doctor’s phone: _____________________________________does participant use wheelchair/walker/other? □yes □no specify: ________________________________________________________can participant transfer from wheelchair? □yes □no is participant subject to seizures? □yes □no Please attach seizure treatment plan.does participant have a communicable disease? □yes □no if yes, please explain: _________________________________________________________________________________________________photo permission: □yes □nowill medication be taken at camp? □yes □no Please attach instructions for medical procedures.list any medication: ___________________________________________________________________________________________________list any allergies: _____________________________________________________________________________________________________
For office use only: SC_____ BF____ LG____ SA requested: Y N SA returned: Y N Date Received:____________________ Previous Year Camp Location:____________________
ACTIVIDADES DEL CAMPAMENTOLas actividades del Campamento pueden incluir:• Natación (Día Completo Solamente)• Deportes • Drama • MúsicaRESIDENTES WSSRASirviendo a los residentes de los Municipios de Harwood Heights y Elmwood Park y Distritos de Parques de Berwyn, Clyde, Forest Park, Franklin Park, Hawthorne, Norridge, North Berwyn, Oak Park y River Forest.FECHAS DE CAMPAMENTOJunio 20 – Julio 29, 2011 Lunes a Viernes.NO hay CAMPAMENTO el Lunes, 4 de JulioCAMPAMENTO DE DÍA-COMPLETO (EDADES 7-22)9:00AM – 3:00PM, Lunes a ViernesDía Completo es una opción si su niño no asiste a la escuelade verano.CAMPAMENTO DE MEDIO-DÍA (EDADES 7-22)Medio día – 3:00PM, Lunes a Viernes• Usted debe indicar en su forma de inscripción si usted esta
inscribiendo para la opción de medio-día.• Hay un número limitado de lugares para campamento de medio
día, y se llenarán de acuerdo de la lotería del Febrero.φ No se puede hacer ajustes de inscripción para los
participantes que asistan escuela de verano.CAMPAMENTO PREESCOLAR (EDADES 3-6)Escoja uno:Sesión de la Manana: No se ofrece natación...... 9:00–11:45AMSesión de la Tarde: No se ofrece natación. ....... 12:15–3:00 PMLOCALIDADES DE LOS CAMPAMENTOSLos campamentos pueden estar localizado en Berwyn, Cícero, Forest Park o Oak Park. Los participantes seran asignado una localizacion basada en edad y descapacidad. Se le notificarán por correo acerca de la localidad del campamento de su niño.TRANSPORTACIÓNTransportación de puerta-a-puerta para el campamento es disponible. Usted debe inscribirse para la transportación cuando complete su forma de inscripción. Lugares limitados de transportación están disponibles. El costo de transportación sera cargada junto con el inscripción de campamento de día. La transportación para el campamento no es proveída para participantes sin discapacidades físicas viviendo dentro de 4 cuadras del sitio del campamento asignado. Los autobuses no tienen aire-condicionado.
COSTO DE CAMPAMENTO DE DÍAOpción de Día-Completo ............................................ $468.00Opción de Medio-Día/Preescolar ............................... $234.00COSTO DE TRANSPORTACIÓNTransportación de Ida ................................................. $211.50Transportación de Ida y Vuelta .................................... $423.00BECASSi no puede pagar el costo de campamento de día, usted puede solicitar ayuda por beca de la oficina WSSRA o descargar la forma de beca de la pagina de internet de WSSRA, www. wssra.net. Es necesario completar y regresar la forma de beca antes de el 4 de febrero de 2011 con su forma de inscripción para el campamento de día. Usted será notificado por correo si usted recibirá una beca y el cantidad de ayuda que recibira. Es necesario asistir 20 días al campamento en 2011 para ser elegible para recibir una beca en el año 2012. Cualquier problema médica debe ser documentado por un médico.PROCEDIMIENTOS DE INSCRIPCIÓN1. Pase en persona, envíe, o mande por fax (847.455.2157) su
inscripción de Campamento de Día de WSSRA.2. Usted debe regresar la Registración de Campamento de Día
totalmente completa, firmada, y fechada antes de el 4 de Febrero de 2011 a la 5:00PM para ser elegible para la lotería. Adicionalmente, la forma de Aplicación de Becas necesita estar en la oficina junto con la forma de inscripcion
de Campamento3. La lotería sera procesado durante el tiempo de el 7 al 18 de
Febrero de 2011.4. Una carta de aceptación al Campamento de Día de WSSRA,
información referente a becas recibidas, y un calendario de pagos sera enviado por correo, comenzando el 23 de Febrero de 2011.
HORARIO DE PAGOS DEL CAMPAMENTO DE DÍA:1. La primera parte de su balance total es debido antes que el 25
de Marzo de 2011.2. La segunda parte de su balance total es debido antes que el
21 de Abril de 2011.3. El pago final se debe antes que el 27 de Mayo de 2011.
Cualquier persona que no termine de hacer sus pagos para el 27 de Mayo puede perder su lugar en el campamento
4. Cancelaciones antes de el 27 de Mayo de 2011 recibirán un reembolso menos $10.00 por costo de proceso. NO HAY REEMBOLSO después del 27 de Mayo de 2011.
Para Preguntas, llame a WSSRA al 847.455.2100
El Campamento de Verano de Día 2011 de WSSRA es diseñado para los participantes edades 3-22, quien tiene una descapacidad y/o recibe servicios de educación especial. Su niño debe tener de 3 -22 años de edad en el primer día de participación del campamento. Inscripción del Campamento de Día es conducido por medio de una lotería. Todas las personas que tienen la edad y requerimientos de inscripción entrarán en la lotería. Si usted no es seleccionado en la lotería para participar en campamento de día, usted será puesto en una lista de espera de acuerdo a la orden en la que quedó en el sorteo. WSSRA ofrece diferentes campamentos de día de acuerdo a la edad y los grupos de habilidad. El campamento provee actividades de recreación apropiada a la edad y al mismo tiempo logra estas metas:• Involucrar a su niño en oportunidades divertidas recreacionales.• Mejorar las habilidades motrices de su niño y aptitud en general.• Fomentar el ambiente en donde su niño pueda lograr y edificar su propia-estima.• Ayudar a mantener o ayudar a que su niño mantenga el incremente de su lenguaje y habilidades de expresión-propia.
Asoc
iación
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Sub
urba
n de R
ecrea
ción E
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a 20
11 PLAZO DE LOTERÍA:4 DE FEBRERO DE 2011
PLAZO DE LOTERÍA: 4 de Febrero de 2011 a las 5:00pmINSCRIPCIÓN DE CAMPAMENTO DE DÍA 2011 DE WSSRA FAX A: 847.455.2157 ENVÍE A: WSSRA, 2915 Maple Street, Franklin Park, IL 60131
SOLICITUD DE BECA □ Pida una Beca□ Participantes de almuerzo gratis programa escolar
OPCIONES DE CAMPAMENTO □ Opcion de 1/2 Dia 7 y mayor□ Opcion de Dia completo 7 y mayor□ AM Preescolar edad 3 a 6□ PM Preescolar edad 3 a 6
OPCIONES DE TRANPORTACIONESmarque UNO□ Transportacion Propia□ WSSRA Viaje Redondo□ WSSRA A La Casa Solamente□ WSSRA Al Campamento
DISCAPACIDAD□ Discapacidad de Aprendizaje□ Discapacidad de Comportamiento □ Impedimento de Audición□ Autismo□ Discapacidad de Desarrollob □ Impedimento de Visión□ Impedimento Físico□ Otro___________________
MEDIDA DE CAMISETA DEL CAMPISTAMedida Niños: □ 6-8 □ 10-12 □ 14-16Medida Adultos: □ S □ M □ L □ XL □ XX □ XXX
Asociación West Suburban de Recreación Especial LIBERACION DE RENUNCIA DE TODO RECLAMO Y CONTIENE ACUERDO INOCUO (LEA CUIDADOSAMENTE)Lea con cuidado por favor esta forma y esté enterado que al inscribirse y tomar parte en programas de la Asociación West Suburban de Recreación Especial, usted estará liberando y renunciando de todo reclamo surgiendo de alguna lesión fuera de estos programas que usted o el participante denominado quizás sostenga. Los términos “yo”, “mí” y “mío” también se refieren a padres o tutores así como participantes en los programas. Al registrarse para estos programas, usted concuerda de la siguiente manera:
Cuando un participante en estos programas, yo reconozco y admito que hay ciertos riesgos de lesiones física, y yo concuerdo en asumir el riesgo total de cualquier lesión, daños o la pérdida que puedo sostener a consecuencia de tomar parte de cualquier manera, en cualquier y toda actividad conectada con o asociado con tales actividades que implica riesgos substanciales de lesiones.
Concuerdo en renunciar y abandonar cualquier y todo reclamo que pueda tener consecuencia por tomar parte en estos programas contra la Asociación West Suburban de Recreación Especial, de cualquier y toda unidad gubernamental participante, cualquier y todo contratista independiente, oficiales, agentes, sirvientes, y empleados de los cuerpos gubernamentales y contratistas independientes, y cualquier y toda persona y entidades de cualquier naturaleza que quizás sea directamente o indirectamente responsable de cualquiera lesión, que yo quizás sostenga al tomar parte en estos programas.
Yo por la presente libero completamente y descargo la Asociación West Suburban de Recreación Especial, y otros partidarios relacionados de cualquier y todo reclamo por lesiones, daños o pérdidas, que pueda tener o que pueda acumulárseme por motivo de que yo tomé parte en estos programas. Concuerdo aún más indemnizar, tener inocuo y defender, a la Asociación West Suburban de Recreación Especial y cualquier y todos los otros partidarios de cualquier y todo reclamo que resulte de un lesión, daño y pérdida sostenidos por cualquiera, y surgiendo fuera de, conectado con o en cualquier manera asociada con mi conducta y las actividades de estos programas.
Comprendo aún más y concuerdo que los términos como “participación, y” actividades”, se refirieren a este acuerdo, incluye todos los ejercicios y movimientos físicos de cualquier naturaleza mientras tome parte en estos programas e incluye aún más la provisión de, o el fracaso para proporcionar instrucciones o supervisión apropiadas, el uso y el ajuste de cualquier y toda maquinaria, equipo, y aparato, y algo relacionado a mi uso de los servicios, las facilidades, o local, implicado en estos programas, y en el transporte a y de acontecimientos.
Comprendo la naturaleza de estos programas para los cuales me registro, y he leído y he comprendido completamente esta Renuncia, Liberación y Tengo Acuerdo Inocuo. Comprendo aún más que cualquier deliberación o las advertencias de riesgos particulares de estos programas que recibo subsiguientemente serán integradas por referencia en y llegan a ser una parte de este Acuerdo.
En caso de emergencia, yo doy mi permiso para que el participante reciba primeros auxilios, transporte o atención médica que pueden ser requeridos.
Yo debo regresar esta liberación y renuncia de todo reclamo por correo o fax. Yo puedo enviar esta liberación al 2915 Maple Street, Franklin Park, IL 60131 o enviar por transmisión facsímil al 847.455.2157. Cuando enviando por fax, es de mutuo entendimiento que el documento facsímil substituirá por y tendrá el mismo efecto legal que la forma original.
FIRMA DEL PADRE/PARTICIPANTE/TUTOR ________________________________________________________________ Fecha___________________
nombre del participante: _____________________________________ □masc. □fem. fecha de nacimiento del participante: ___/ ___ / _____padre/guarda legal 1: _______________________________________ padre/guarda legal 2: ________________________________________ dirección: _________________________________________________ ciudad: _____________________________ código postal: __________tel de casa: _________________________________ distrito de parque/municipalidad _____________________________________________
correo electrónico: tel del trabajo 1 (de quien?): __________________________________ tel del trabajo 2 (de quien?): __________________________________tel cel 1 (de quien?): ________________________________________ tel cel 2 (de quien?): ________________________________________persona contacto de emergencia(otra persona que no sea el padre): _______________________ teléfono de emergencia: __________________escuela: ___________________________________________ maestro(a): _______________________________________________________nombre de doctor: _________________________________________________ teléfono de doctor: ___________________________________¿el participante usa silla de ruedas/andador/otros? □si □no especifico: ____________________________________________________¿puede el participante transferirse de la silla de ruedas? □si □no ¿es el participante sujeto asimientos/attaques? □si □no Por favor adjunte su plan de tratamiento para attaques.¿tiene el participante alguna enfermedad contagiosa? □si □no si la tiene, por favor explique: ___________________________________________________________________________________________permiso para fotos: □si □noel participante toma medicacion durante el campamento?: □yes □no Por favor adjunte instrucciones para procedimientos médicos.¿qué medicamento se estará tomando en el campamento? ____________________________________________________________________lista de cualquier alergia: ______________________________________________________________________________________________
For office use only:For office use only: SC_____ BF____ LG____ SA requested: Y N SA returned: Y N Date Received:____________________ Previous Year Camp Location:____________________
19 WSSRA.NET
REGISTRATIONNUMBER DATE DROP OFF &
PICK UP TIMES ACTIVITY DESTINATION FEE
131-01 02/05 9:30am-12:30pm
Happy, Happy Birthday!- Let’s celebrate the birthdays of our forefathers and President’s Day in the month of February.
Forest Park Bldg #4 $13.70
Special Notes: Dress for the weather for outdoor activities. 131-02 02/12 9:30am-
12:30pmMonkey’n Around- We’re going to the zoo to see lions and tigers and bears, oh my!
Lincoln Park Zoo $13.70
Special Notes: Dress for the weather. 131-03 02/19 9:30am-
12:30pmMad Scientists- Put your lab coats on to make wacky science experiments in the Forest Park laboratory!
Forest Park Bldg #4 $13.70
Special Notes: Note allergies. 131-04 02/26 9:30am-
12:30pmGet into “The Grove”- Explore the 123 acres of prairie grove land and learn about hawks and owls in the Natural Science Classroom.
The Grove, Glenview $13.70
Special Notes: Dress for the weather. 131-05 03/05 9:30am-
12:30pmDuPage Children’s Museum- Explore the different neighborhoods of the museum including waterworks, airworks, make it move and much more!
Dupage Children’s Museum, Naperville
$13.70
Special Notes: Dress in layers for indoor play.131-06 03/12 9:30am-
12:30pmLeaping Leprechauns- Go on a scavenger hunt for 4 leaf clovers, play games, and make a craft to celebrate St. Patty’s Day.
Forest Park Bldg #4 $13.70
Special Notes: Dress for the weather. 131-07 03/19 9:30am-
12:30pmSwimmin’ @ Concordia- Enjoy the warm pool at Concordia University for open swim. Pool is not accesible to wheel chairs.
Concordia University, River Forest
$13.70
Special Notes: Dress for the weather. 131-08 03/26 9:30am-
12:30pmIndian Boundary Park & Cultural Center- Check out the duck filled lagoon and zoo area with goats, sheep, chickens, and ducks!
Indian Boundary, Chicago
$13.70
Special Notes: Dress for the weather.
School-AgedRegistration Number: OUTDOOR ADVENTURES
MI, DD, LD, VIJoin us for a Saturday morning of thrills and excitement as we explore our communities with a special focus on our environment! Register for one or all 8 exciting events. Van will not wait longer than 5 minutes past start time for traveling programs.
Age: 12-22 YearsDate: Saturdays, Feb 5 – Mar 26, 2011Time: 9:30-12:30 PMLocation: Park District of Forest Park Building #4
20 WSSRA.NET
Sports & FitnessSPECIAL OLYMPICSIllinois Special Olympics provides year round sports training in a variety of Olympic-type sports for children and adults with mental impairments or closely related developmental disabilities who are 8 years of age or older. The program gives athletes opportunities to develop physical fitness, demonstrate courage, experience joy and participate in the sharing of skills and friendship with their families and other athletes. WSSRA supports the mission of Special Olympics through the participation in the following sports:Track & Field, Softball, Aquatics, Basketball, Bowling, Volleyball, and Golf
CRITERIA FOR PARTICIPATIONAll Special Olympic athletes must have a current, completed Application for Participation in Illinois Special Olympics form on file with the Special Olympic coordinator at WSSRA. This form contains four sections:1. Athlete Information2. Parent and/or Guardian Authorization & Medical
Authorization3. Health Insurance and Emergency Information4. Medical Clearance (This MUST be completed by a
physician).Applications for Participation in Illinois Special Olympics are valid for 2 years based on the earliest signed date on the medical application form. We can FAX the medical application form to you today. Anyone interested in participating, starting a new sport, or volunteering, please contact: WSSRA Special Olympics Coordinator, 2915 Maple Street, Franklin Park, IL 60131, 847.455.2100.
WDSRA & SO DISTRICT AQUATICS MEETSMI, AUT, DDStingray Swim Team Members- the swim meet that you’ve been preparing for all year! You’ll have the opportunity to qualify for the Illinois Special Olympic State Games. Transportation is provided by pick-up points. All registrants must have a current ISO Medical on file to participate. See eligibility information above.
Age: 8 Yrs & OlderRegistration deadline: Feb 1, 2011133-01: WDSRA Aquatics Meet: Saturday, Feb 5, 2011Location: West Chicago High SchoolFee: $15.00 Trans: $2.75133-02: District Aquatic Meet: Wednesday, Mar 2, 2011Location: Neuqua Valley High School, NapervilleFee: Free Trans: $2.75
WSSRA STINGRAY SWIM TEAM Stingray Swim Team is a training program for participants who are comfortable in the water. Participants will be expected to swim consecutive laps throughout a majority of the program. Those wishing to compete in Special Olympics can receive their training in the program but are not obligated to compete with WSSRA. Bring a suit and towel. Transportation is available on a limited basis. Please Note: Due to the limited swim lessons available, swim team members are not eligible for swim lessons.
Date: Mondays, Jan 31 – Mar 21, 2011 (No program Feb 21, Mar 7)Time: 7:00-8:10 PM (Pool time 7:05-8:10)Location: OPRFHS (Facility Pending)Fee: $37.50 Trans: $36.30Registration Number: 141
TEEN & ADULT AQUA ATHLETICSMLH, MI, AUT, DDEnjoy one of the greatest modes of exercise. Through water, participants can increase their:• cardiovascular system• strength• flexibility• mobility• range of motionAll while having fun in the pool with friends.
Age: 15 Years & OlderDate: Mondays, Jan 31 – Mar 21(No program Feb 21, Mar 7)Time: 8:15 - 9:00 PMLocation: OPRFHS (Facility Pending)Fee: $32.00 Trans: $36.30Registration Number: 148
SEASPAR BOWLING TOURNAMENTIf a participant is signed up for WSSRA Saturday Bowling, he or she may choose to compete in the SEASPAR Tournament. REGISTRATION DEADLINE IS MARCH 1, SIGN UP TODAY! Transportation provided from pick up points to be announced.
Date: Saturday, Apr 16, 2011Time: Noon - 4:30 PMLocation: Willowbrook Lanes, WillowbrookFee: $20.00 Trans: $2.75Registration Number: 238
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21 WSSRA.NET
Sports & FitnessBOBCATS BASKETBALL
MI, AUT, DDAll teens and adults who are interested in joining the WSSRA Bobcats Basketball Team, register now! Practices and games will be held on Tuesday evenings. During the WINTER season participants will practice and prepare for the game season which begins at the end of December and goes through the end of March. All participants must participate in the practice season in order to be a part of the game season.
Bobcat Basketball Philosophy: In establishing the Bobcat’s basketball program, the WSSRA has set criteria the program will follow. WSSRA will emphasize teamwork, good sportsmanship, and giving one’s best in a safe and healthy environment. Competitiveness will come from the game itself and not from emphasis on the score. Each player will:• Practice & develop ball handling, dribbling & shooting. • Learn about play development.• Be a part of a team and learn the importance of teamwork.• Learn and play different positions.More information about the game schedule and locations will be available upon registration. NOTE: YOU MUST BE IN THE 1ST SESSION TO BE ABLE TO JOIN AND COMPETE IN GAMES IN THE 2ND SESSION.New players must purchase a uniform before being able to compete on the Bobcats basketball team.
Age: 15 Years & OlderSession II Game season Date: Tuesdays, Jan 1 - Feb15, 2011Time: 6:30-8:00 PM (Time may vary based on location)Game locations: Check the website: WSSRA.net or contact Annie Lhotka for up to date game information 847-455-2100Fee: $120.00 for Session I & IIRegistration Number: 199
WEEKLY WORKOUTMI, AUT, DD, MLHLet’s work out! It’s a great way to end your day and improve your physical condition through:• exercise stations• light weight lifting• low impact aerobicsWSSRA will provide door to door transportation.
Age: 13 Years & olderDate: Tuesdays, Feb1 - Mar 22, 2011Time: 7:00-8:15 PMLocation: Franklin Park Community CenterFee: $36.00 Trans: $48.40Registration Number: 147
ISO TRACK & FIELD CLINICMI, AUT, DD, MHCome out and train for the Special Olympic Track & Field team. Weekly programs will include warm up & practice for these events: softball throw, short running race, & long jump. Participants will have the opportunity to participate in the Regional Special Olympic Meet in SPRING and will automatically be registered for SPRING Games on Sunday, May 1, 2011. All participants must have a current Special Olympic medical on file by March 1, 2011 to participate in SPRING Games. See page 11 for form. Participants must be registered for winter and spring training session to compete.
Age: 13 Years & OlderDate: Wednesdays, Feb 2 - Mar 23, 2011Time: 7:15-8:30 PMLocation: Cicero Community CenterFee: $36.00 Trans: $48.40Registration Number: 142
GOOD SPORTSMANSHIPWSSRA encourages parents and families to attend games and tournaments and cheer the teens/young adults on! We expect coaches, players and parents to demonstrate good sportsmanship during these events. This includes respect and support of coaching staff and officials who are working on behalf of your player. Any person not demonstrating good sportsmanship including behavior outbursts towards a player or coaching staff and/or officials, that is deemed threatening, will not be tolerated. You may be asked to leave and your future participation and attendance at events will be in jeopardy. By registering your son/daughter/dependent for these programs you are agreeing to follow these guidelines as written. Please refer any concerns or questions to the Superintendent of Recreation. We look forward to a safe and successful season.
T
T
APPLIC
ATION
FOR
PAR
TICIPATIO
N IN
SPECIA
LO
LYMPIC
S ILLINO
ISValid A
pplication for Participation is m
andatory for all competitors
605 E. W
illow St.
Norm
al, IL61761-2682
309-888-2551
ATHLETE
INFO
RM
ATION
MED
ICA
LC
LEAR
AN
CE
HEA
LTH IN
SUR
AN
CE &
EMER
GEN
CY
INFO
RM
ATION
(Required for Processing)
PAR
ENT A
ND
/OR
GU
AR
DIA
N A
UTH
OR
IZATION
AN
D M
EDIA
RELEA
SE
Athlete N
ame (last nam
e, space, first name)
Athlete’s M
ailing Address
StateZip C
ode
-
Birthdate
M M
D D
YY
Sex (M
or F)
--
Athlete’s C
ity
Parent’s/G
uardian’s (Please C
ircle One) H
ome A
ddress
Parent’s/G
uardian’s H
ome Telephone
Agency N
ame
Person to be contactedin case of em
ergencyM
edical Insurance Com
pany
Emergency
Contact Phone ( )
Policy Num
ber
I, on my ow
n behalf or as the undersigned parent and/or legal guardian of the above named applicant (hereafter referred to as the “E
ntrant”), hereby request permission for the
Entrant to participate in Special O
lympics program
s. I acknowledge that Special O
lympics w
ill screen all entrants using the Sex O
ffender Public R
egistry and the Child M
urder andViolent O
ffender Against Youth R
egistry and understand that entrants listed on either Registry w
ill be denied participation. I affirm that this
Entrant has never been on said R
egistriesor, if E
ntrant was listed on either R
egistry but has since been removed, I w
ill contact SpecialOlym
pics Illinois for instructions before submitting this application.
I represent and warrant to you that the Entrant is physically and m
entally able to participate in Special Olym
pics, and I submit herew
ith a subscribed medical certificate. I understand that
if the athlete has Dow
n Syndrome, he/she cannot participate in sports or events w
hich, by their nature result in hyper-extension, radical flexion or direct pressure on the neck or upperspine unless a full radiological exam
ination establishes the absence of Atlantoaxial Instability. I am aw
are that the sports and events for which this radiological exam
ination is requiredare equestrian sports, artistic gym
nastics, diving, pentathlon, high jump, alpine skiing, soccer, soccer skills, pow
erlifting squat and butterfly stroke and diving starts in swim
ming.
On behalf of the E
ntrant and myself, I acknow
ledge that the Entrant w
ill be using facilities at his/her own risk and I, on m
y own behalf, herby release, discharge and indem
nifySpecial O
lympics from
all liability for injury to person or damage to property of m
yself and Entrant.
In permitting the E
ntrant to participate, I am specifically granting perm
ission to Special Olym
pics Illinois to use the likeness, voice and words of the E
ntrant in television, radio, films,
newspapers, m
agazines and other media, and in any form
not heretofore described, for the purpose of advertising or comm
unicating the purposes and activities of SpecialO
lympics 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 O
lympics H
ealthy Athletes
Program
that provides individual screening assessments of health status and health care needs. The E
ntrant has no obligation to participate and I understand the Entrant should
seek his/her own m
edical advice and assistance and Special Olym
pics is not responsible for the Entrant’s health.
If I am not personally present at Special O
lympics activities in w
hich the Entrant is to com
pete, so as to be consulted in case of necessity, you are authorized on my behalf and at
my account to take such m
easures and arrange for such medical and hospital treatm
ent as you may deem
advisable for the health and well-being of the E
ntrant.I, TH
E UN
DER
SIGN
ED A
DU
LT ENTR
AN
T,have read and fully understand the provisions of the above release and/or have had them
explained. I hereby agree that Iw
ill be bound thereby and I shall defend Special Olym
pics Illinois and hold it harmless
from disaffirm
ation thereof.
Entrant
Witness
Date
Athlete’s E
mail A
ddress
I, THE U
ND
ERSIG
NED
PAR
ENT A
ND
/OR
GU
AR
DIA
Nof the above specified
Entrant, have read and fully understand the provisions of the above release and have
explained them to said E
ntrant. I hereby agree that I and said minor w
ill be boundthereby, and I shall defend Special O
lympics Illinois and hold it harm
less from any
disaffirmation thereof by said m
inor.S
ignature of Parent
and/or Legal Guardian
(Check appropriate box)
Print N
ame
Date
Parent’s E
mail A
ddress
PLEASE C
HEC
K M
EDIC
AL
INFO
RM
ATION
Does athlete have D
own S
yndrome?
YesN
oIf yes, have x-rays of the C
1-C2 vertebrae
been taken and examined?
YesN
oD
ate of x-rayIs the athlete clear
of Atlantoaxial Instability?Yes
No
Does the athlete have or is the athlete:H
eart Problem
sYes
No
Diabetic
YesN
oE
pileptic/Seizures
YesN
oB
lindYes
No
Deaf
YesN
oH
epatitisYes
No
Other
Current M
edicationD
osage
Allergies to m
edication, if any:
Date of last Tetanus shot:
I have examined the above-nam
ed Entrant
and, in my opinion, there is no m
ental or physical reason w
hy he or she should not participate in the Special O
lympics sports
training and competition program
. Further inform
ation will be forw
arded if required.C
urrent medication, if any, is specified w
ith dosage on this application.
Exam
ination Date
Doctor’s S
ignature
Print N
ame
Address
City
State Zip
Phone ( )
SOILL
OFFIC
EO
NLY
Zip Code
-
State
Parent’s/G
uardian’s City
EthnicityW
hiteB
lack/African A
merican
Hispanic/Latino
Other
Asian
Original parent/guardian and doctor signatures are required by the office of Special O
lympics Illinois. Faxed signatures w
illnotbe accepted.
SOILL
Rev. 8-1-10
23 WSSRA.NET
SPECIAL OLYMPICTRAINING & SPORTS
MI, AUT, MH, DDEnjoy an afternoon of fitness fun and Special Olympic Track & Field Training. Participants will:• Practice for softball throw, short running and
long jump events.• Stretch & do warm up exercises.• Learn healthy eating by having healthy
snacks.Participants will automatically be registered for SPRING Games on Sunday, May 1, 2011. All participants must have a current Special Olympic medical form on file by March 1, 2011 to participate in SPRING Games. See page 22 for form.
Date: Thursdays, Feb 3 - Mar 24, 2011Time: 3:45-5:15 PMLocation: PAV Berwyn YMCA, BerwynFee: $43.20 Trans: $48.40Registration Number: 132
SATURDAY BOWLING LEAGUE MI, AUT, DD, SP, MHSpend your Saturdays with friends while sharpening your bowling skills through practice and instruction. An adaptive ball and bowling ramp will be available.
Age: 13 Years & olderLocation/Pick Up/Drop off:WSSRA Office, Franklin Park/11:55 AM/3:55 PMHarwood Heights Village Halll/12:10 PM/3:15 PMElmwood Park Recreation Center/12:30 PM/3:20 PMMcDonalds, 5500 Cermak, Cicero/12:30 PM/3:20 PMDate: Saturdays, Feb 5 – Mar 26, 2011Time: 1:00 3:00 PMLocation: Circle Lanes, Forest ParkFee: $70.00Pick up Point Trans: $22.00Registration Number: 110
Sports & Fitness
“I love bowling buddies! You get two turns!”he said with a fist pump
CarlosArrez
BROADWAY TOURHI, VI, PI MLH, DDSee live Broadway productions. Sign up for one or all three events. Registered participants will be notified of the actual show dates once WSSRA is able to secure tickets after the ticket release date. Once you are notified of the actual show date and time you are obligated to the ticket. Ticket prices may vary from list below: Participants need to be able to focus on a 2+ hour performance with minimal interruptions. This is to minimize the disturbance to other audience members.
Age: 15 years and upReg. # Date Activity Destination Fee
181 2/8/11 – 2/13/11
Rain: A tribute to the Beatles RAIN covers The Beatles from the earliest beginnings through the psychedelic late 60s and their long-haired hippie, hard-rocking rooftop days.
Ford Center/Oriental Theatre, Chicago
$40.00
381 6/28/11 – 7/10/11
Beauty and the Beast Experience the romance and enchantment of DISNEY’S BEAUTY AND THE BEAST!
Ford Center/Oriental Theatre, Chicago
$40.00
481 11/13/11 The Sound of Music Experience the enchanting story of Maria & the 7 Von Trapp children.
Drury Lane Theatre, Oak Brook Terrace
$40.00
PPT
24 WSSRA.NET
SOCIALITES: pick up & drop off @Carroll Center
DANCE FEVERTonight we will join our friends at Answer Inc. for the annual Dance Fever. Don’t miss an opportunity to dance the night away!Date: 1/15/11 Time: 5:00 – 9:00pm Registration Number: 176-01Destination: River Forest Community Center, River Forest Pick-up/Drop-off: Carroll Recreation Center Fee: $12.00
ICE SKATINGLet’s take advantage of the chilly weather and have some winter fun ice skating with our friends! Bring $9 for skate rentals & hot cocoa.Date: 2/5/11 Time: 6:00 – 9:00 pm Registration Number: 176-02Destination: Daley Bicentennial Ice Skating Rink Fee: $16.00
UIC FLAMESHelp us cheer on the Flames tonight as we travel to the UIC Pavilion to watch the Flames play Milwaukee. Go Flames!!! Bring money for snack.Date: 2/12/11 Time: 4:00-8:30 pm Fee: $16.00Destination: UIC Pavilion Registration Number: 176-03
SNOW-MUCH FUN!!!It’s a winter wonderland! Let’s get together to build some snowmen and drink some hot cocoa.Date: 2/19/11 Time: 6:00-9:00pm Fee: $12.00Destination: Carroll Center Registration Number: 176-04
ONCE ON THIS ISLANDLet’s head over to OPRF High School and see a captivating musical that tells a story of two different societies on a Caribbean Island.Date: 2/26/11 Time: 6:00-9:45pm Fee: $18.00Destination: OPRFHS Registration Number: 176-05
MARDI GRAS MASQUERADE BALLIt’s a bead bash! Join all your friends for Mardi Gras inspired activities and music.Date: 3/5/11 Time: 6:00–9:00pm Destination: Carroll CenterFee: $12.00 Registration Number: 176-06
SHAM-ROCK THE HOUSEIt’s a Patty’s day celebration. Gather round for some festive activities and snacks. Meet at Forest Park Park District.Date: 3/12/11 Time: 6:00–9:00pm Destination: Park District of Forest Park Fee: $12.00 Registration Number: 176-07
MAD SCIENTISTSSlip on a lab coat and let’s do some MAD science! Join fellow scientists to make some experiments and transform the Barrie Center into our own laboratory!Date: 3/19/11 Time: 6:00–9:30pm Registration Number: 176-08Destination: Carroll Center Fee: $12.00
ICE MELTIN’ BLUESWe’re heading to Long Grove to listen to some music, walk around, and do some window shopping. Bring $5 for snack.Date: 3/26/11 Time: 6:00-9:00pm Registration Number: 176-09Destination: Long Grove Fee: $16.00
HOT SHOTS: pick up & drop off @Carroll Center
DANCE FEVERTonight we will join our friends at Answer Inc. for the annual Dance Fever. Don’t miss an opportunity to dance the night away!Date: 1/15/11 Time: 5:00 – 9:00pm Registration Number: 173-01Destination: River Forest Community Center, River Forest Pick-up/Drop-off: Carroll Recreation Center Fee: $12.00
IT’S ALL FUN AND GAMESBored??? Join your friends for an exciting night filled with board, video games, and lots of fun!Date: 2/5/11 Time: 6:00 – 9:00pm Registration Number: 173-02Destination: Carroll Center Fee: $12.00
UIC FLAMESHelp us cheer on the Flames tonight as we travel to the UIC Pavilion to watch the Flames play Milwaukee. Go Flames!!! Bring money for snack.Date: 2/12/11 Time: 4:00-8:30pm Registration Number: 173-03Destination: UIC Pavilion Fee: $16.00
ICE SKATINGLet’s take advantage of the chilly weather and have some winter fun ice skating with our friends! Bring $9 for skate rentals & hot cocoa.Date: 2/19/11 Time: 6:00-9:00pm Registration Number: 173-04Destination: Daley Bicentennial Ice Skating Rink Fee: $16.00
SNOW-MUCH FUN!!!It’s a winter wonderland! Let’s get together and build some snowmen and drink some hot cocoa.Date: 2/26/11 Time: 6:00-9:45pm Registration Number: 173-05Destination: Carroll Center Fee: $12.00
SIGHTSEEING SCAVENGER PHOTO TOURLet’s head to the city and take some pictures in front of some historical and Chicago landmarks! Snap!Date: 3/5/11 Time: 6:00–9:00pm Registration Number: 173-06Destination: Chicago Fee: $16.00
SHAM-ROCK THE HOUSEIt’s a Patty’s day celebration. Gather round for some festive activities and snacks. Meet at Forest Park Park District.Date: 3/12/11 Time: 7:00-10:00pm Destination: Park District of Forest Park Fee: $12.00 Registration Number: 173-07
OAK PARK ICE SHOWWe’re going to the Paul Hruby Ice Arena to watch talented skaters strut their stuff on the ice! Fee: $18.00Date: 3/19/11 Time: 6:00-9:30pm Registration Number: 173-08Destination: Paul Hruby Ice Arena at Ridgeland Common
ZUMBAZUMBA is a fusion of Latin and International music. Join us as an instructor leads us with energetic and easy to follow dance moves!Date: 3/26/11 Time: 6:00-9:00pm Destination: Carroll Center Fee: $16.00 Registration Number: 173-09
Program Location: Carroll Center, 1125 S Kenilworth, Oak Park Pick Up Point: WSSRA Office, 2915 Maple Street, Franklin Park or McDonalds, 5500 Cermak (West of Laramie), Cicero Pick up Point Transportation: $2.75 per week Ability Group: DDMI 15 years and older
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CITY SLICKERS: pick up & drop off @Barrie Center
DANCE FEVERTonight we will join our friends at Answer Inc. for the annual Dance Fever. Don’t miss an opportunity to dance the night away!Date: 1/15/11 Time: 5:00 – 9:00pm Registration Number: 174-01Destination: River Forest Community Center, River Forest Pick-up/Drop-off: Barrie Recreation Center Fee: $12.00
ZUMBAZUMBA is a fusion of Latin and International music. Join us as an instructor leads us with energetic and easy to follow dance moves!Date: 2/5/11 Time: 6:00 – 9:00 pm Registration Number: 174-02Destination: Barrie Center Fee: $16.00
UIC FLAMESHelp us cheer on the Flames tonight as we travel to the UIC Pavilion to watch the Flames play Milwaukee. Go Flames!!! Bring money for snack.Date: 2/12/11 Time: 4:00-8:30 pm Fee: $16.00Destination: UIC Pavilion Registration Number: 174-03
ICE SKATINGLet’s take advantage of the chilly weather and have some winter fun ice skating with our friends! Bring $9 for skate rentals & hot cocoa.Date: 2/19/11 Time: 6:00 – 9:00 pm Registration Number: 174-04Destination: Daley Bicentennial Ice Skating Rink Fee: $16.00
SNOW-MUCH FUN!!!It’s a winter wonderland! Let’s get together to build some snowmen and drink some hot cocoa.Date: 2/26/11 Time: 6:00-9:45pm Fee: $12.00Destination: Barrie Center Registration Number: 174-05
SIGHTSEEING SCAVENGER PHOTO TOURLet’s head to the city and take some pictures in front of some historical and Chicago landmarks! Snap!Date: 3/5/11 Time: 6:00–9:00pm Registration Number: 174-06Destination: Chicago Fee: $16.00
SHAM-ROCK THE HOUSEIt’s a Patty’s day celebration. Gather round for some festive activities and snacks. Meet at Forest Park Park District.Date: 3/12/11 Time: 6:00–9:00 pm Registration Number: 174-07Destination: Park District of Forest Park Fee: $12.00
OAK PARK ICE SHOWWe’re going to the Paul Hruby Ice Arena to watch talented skaters strut their stuff on the ice! Fee: $18.00Date: 3/19/11 Time: 6:00-9:30pm Registration Number: 174-08Destination: Paul Hruby Ice Arena at Ridgeland Common
MAD SCIENTISTSSlip on a lab coat and let’s do some MAD science! Join fellow scientists to make some experiments and transform the Barrie Center into our own laboratory!Date: 3/26/11 Time: 6:00-9:00pm Registration Number: 174-09Destination: Barrie Center Fee: $12.00
MOONLIGHTERS:pick up & drop off @Barrie Center
DANCE FEVERTonight we will join our friends at Answer Inc. for the annual Dance Fever. Don’t miss an opportunity to dance the night away!Date: 1/15/11 Time: 5:00 – 9:00pm Registration Number: 175-01Destination: River Forest Community Center, River Forest Pick-up/Drop-off: Barrie Recreation Center Fee: $12.00
ICE SKATINGLet’s take advantage of the chilly weather and have some winter fun ice skating with our friends! Bring $9 for skate rentals & hot cocoa.Date: 2/5/11 Time: 6:00 – 9:00 pm Registration Number: 175-02Destination: Daley Bicentennial Ice Skating Rink Fee: $16.00
UIC FLAMESHelp us cheer on the Flames tonight as we travel to the UIC Pavilion to watch the Flames play Milwaukee. Go Flames!!! Bring money for snack.Date: 2/12/11 Time: 4:00-8:30 pm Fee: $16.00Destination: UIC Pavilion Registration Number: 175-03
SNOW-MUCH FUN!!!It’s a winter wonderland! Let’s get together to build some snowmen and drink some hot cocoa.Date: 2/19/11 Time: 6:00-9:00pm Fee: $12.00Destination: Barrie Center Registration Number: 175-04
ONCE ON THIS ISLANDLet’s head over to OPRF High School and see a captivating musical that tells a story of two different societies on a Caribbean Island.Date: 2/26/11 Time: 6:00-9:45pm Fee: $18.00Destination: OPRFHS Registration Number: 175-05
MARDI GRAS MASQUERADE BALLIt’s a bead bash! Join all your friends for Mardi Gras inspired activities and music.Date: 3/5/11 Time: 6:00-9:00pm Destination: Barrie CenterFee: $12.00 Registration Number: 175-06
SHAM-ROCK THE HOUSEIt’s a Patty’s day celebration. Gather round for some festive activities and snacks. Meet at Forest Park Park District.Date: 3/12/11 Time: 6:00–9:00pm Registration Number: 175-07Destination: Park District of Forest Park Fee: $12.00
MAD SCIENTISTSSlip on a lab coat and let’s do some MAD science! Join fellow scientists to make some experiments and transform the Barrie Center into our own laboratory!Date: 3/19/11 Time: 6:00-9:30pm Registration Number: 175-08Destination: Barrie Center Fee: $12.00
ICE MELTIN’ BLUESWe’re heading to Long Grove to listen to some music, walk around, and do some window shopping. Bring $5 for snack.Date: 3/26/11 Time: 6:00-9:00 pm Registration Number: 175-09Destination: Long Grove Fee: $16.00
Program Location: Barrie Center, Garfield & Lombard, Oak Park Pick Up Point: WSSRA Office, 2915 Maple Street, Franklin Park or McDonalds, 5500 Cermak (West of Laramie), Cicero Pick up Point Transportation: $2.75 per week Ability Group: DD, MI 15 years and older
NEW TO SATURDAY NIGHTS – CALL THE OFFICE FOR GROUP PLACEMENT 847.455.2100
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WINTER ESCAPEMI, DDPlan ahead and register for a lively winter overnight experience shared with our friends from NISRA. Weather permitting, participants will: • Enjoy a winter horseback ride• Cross Country Ski • Hike & Sled • Play Snow Volleyball • Enjoy A Camp FireParticipants must be:• Toilet Trained.• Responsible for independent personal care including feeding, dressing & toileting.• Devoid of emotional outbursts that require 1:1 staffing.• Participant is successful socially within 1 staff person per 1 participants staffing ratio.More information will be sent upon registration.
Age: 13 Years & OlderDate: Jan 14, 15, 16, 2011Depart & return from WSSRA OfficeLocation: White Pines Ranch, Oregon, IllinoisFee: $220.00Registration Number: 146
re-DESIGNMLH, MI, DDFill your Thursday evenings with the excitement of taking something old and making it new. This four week class will consist of a weekly project and one personal ongoing project. Projects could include: renewing an old lamp shade, creating and designing a handbag. The sky is the limit! We will conclude the season with a showcase of our wares.
Age: 19 Years & OlderDate: Thursdays, Feb 3, 10, 17, 24, 2011Time: 7:00-8:30 PMLocation: Elmwood Park Recreation Center (Facility Pending)Fee: $15.60 Trans: $24.20Project fee: $15.00Registration Number: 130-01
iDANCEMLH, MI, DDLearn the latest moves and groove to your favorite hip hop tunes. Join us for four weeks of fun times.
Age: 19 Years & OlderDate: Thursdays, Mar 3, 10, 17, 24, 2011Time: 7:00-8:30 PMLocation: Elmwood Park Recreation Center (Facility Pending)Fee: $15.60 Trans: $24.20Registration Number: 130-02
SHOW TIMEMI, AUT, DDEnjoy a night at the movies with friends. Participants need to bring $20.00 to pay for the show and snacks. Meeting time will be based on local show schedule. Call the office the Wednesday before program for information on show time. Participants need to be able to focus on a movie 2 hours in length with limited breaks. This is to minimize the disturbance to other audience members. Registration is limited.
Age: 15 Years & OlderCarroll Recreation Center, Oak Park locations onlyPick up Points available: WSSRA Office: 5:15 PM, 10:00 PMCicero McDonalds: 6:15 PM, 9:15 PMRegistration Number: 160-01 Friday, Feb 11, 2011Fee: $12.50 Trans: $2.75Registration Number: 160-02 Friday, Mar 11, 2011Fee: $12.50 Trans: $2.75
FOOD CRITICSMLH, MI, AUT, DDCome with us and compare the tastes and surroundings of six local “Family Restaurants.” Lively discussions about what we liked best each week will be part of the fun. Bring $20 to cover your food and share of the tip. Participants need to be able to sit for a meal with minimal interruptions to others.
Age: 15 Years & OlderDate: Fridays, Feb. 4, 18 Mar 4, 18, 2011Time: 6:30-9:15 PM Location: Carroll Center, Oak ParkFee: $12.00 per weekTransportation: $2.75 per week/ $16.50 for 6 weeksPick up points:WSSRA Office: 5:15 PM, 10:00 PMCicero McDonalds: 6:15 PM, 9:15 PM
Regist # Date Restaurant Location161-01 Feb 4 Mother’s Day North Riverside161-02 Feb 18 Kopper Kitchen Elmhurst161-03 Feb 25 Omega Lombard161-04 Mar 4 Connies Berwyn161-05 Mar 18 Family Palace Harwood Heights161-06 Mar 25 Elmwood Family Restaurant Elmwood Park
Teens & Young Adults
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WALK’N DINEHI, VI, PI, MLHJoin the WSSRA Walking Club and get walking to a healthier heart while enjoying friends too! The group will walk or wheel at different locations. Afterwards, join us for an enjoyable, light, healthy lunch together at different local restaurants. Participants will be responsible for buying their own lunch. Participants must be independent in mobility. Sign up for the weeks that fit your schedule!
Date: Tuesday, February 1 – March 22, 2011Time: 9:30 AM-12:30 PMLocation: VariesFee: $11.00 week / $88.00 all Trans: $6.05 week / $48.40Program # Date Location167-01: February 1 North Riverside Mall167-02: February 8 Harlem-Irving Plaza167-03: February 15 North Riverside Mall167-04: February 22 Golf Mill167-05: March 1 North Riverside Mall167-06: March 8 Harlem-Irving Plaza167-07: March 15 North Riverside Mall167-08: March 22 Yorktown
WILD CARD WEDNESDAYSHI, VI, PI, MLHJoin us for an early morning of socializing and card shuffling fun! Light & healthy refreshments will be served. Participants can register for one or all of the weeks.
Time: 9:30 AM-12:30 PMLocation: Franklin Park Community CenterFee: $83.20 / 8 weeks ($10.40 per week) Trans: $48.40 / 8 weeks ($6.05 per week) Date: Wednesdays 165-01: February 2165-02: February 9165-03: February 16165-04: February 23165-05: March 2165-06: March 9165-07: March 16165-08: March 23
WINNER TAKES ALL HI, VI, PI, MLHJoin us for a night of socializing, laughter & games. We will learn a different game as well as play some old favorites. Each week we will order dinner “take-out” from a local favorite. Bring $10 for dinner.
Date: Thursdays, February 3 – March 24Time: 6:00-8:30 PMLocation: WSSRA Office, Franklin ParkFee: $7.45 per week / $45.00 6 weeksTrans: $6.05 per week / $36.30 6 weeksRegistration Number: 162
Older Adults
REGISTRATION NUMBER DATE DROP OFF &
PICK UP TIMES ACTIVITY DESTINATION FEE
171-01 2/11/11 10:00am-2:00pm
Valentine’s Day Party with the residents of Franklin Towers. We’ll celebrate the loving holiday with takeout lunch, a romantic craft, and games.
Franklin Towers $8.00
Special Notes: Bring $10 for lunch.171-02 3/11/11 10:00am-
2:30pmArt Institute of Chicago. We’ll travel to the Art Institute where we’ll join a guided audio tour that you can follow at your own pace. Lunch at the Garden Café.
Art Institute of Chicago
$12.00
Special Notes: Please bring $15 for Lunch.171-03 3/25/11 10:00am-
2:00pmTravel to the Aurora Outlet Mall where we’ll shop for the deals.
Aurora Outlet Mall $8.00
Special Notes: Bring $ for shopping.
CITY TOURSHI, VI, PI, MLH Join us Friday mornings! Select the week(s) that are of your interest and meet your budget. Each program is separate. Please share your ideas for future events. Admission costs to activities are covered in the fee. Due to tour time schedules, there may not be a planned lunch stop. Door to door transportation is available.
Time: 10:00 AM - 2:00 PM (Fridays)Fee: See each event Trans: $6.05 per week
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YOU’RE INVITED TO AGOLF “PAR-TEE” FUNDRAISEREnjoy 3 hours of golf fun: driving range, swing evaluation, longest drive competition, virtual golf, drinks, refreshments & tips from a pro.
Date: February 5, 2011Check our web site, www.wssra.net for updates.
Location: White Pines Golf Dome at the White Pines Golf Course 500 W Jefferson Street, Bensenville(Funds raised support WSSRA programs)Call 847.455.2100 to RSVPRegistration Number: 197
WINTER FESTALL ABILITES - ALL AGESCrafts, games & winter fun are all a part of our winter family fest. Bring supplies (hat, scarves, etc.) to enter our Snowman building contest - the more creative the better! Snowman contest winners will be awarded at 2:30 PM - don’t be late. Alternative indoor activities planned if weather does not cooperate. Please register by February 1, 2011.
Date: Sunday, February 6, 2011Time: 1:00-3:00 PMLocation: TBAFee: Free Registration Number: 196
FLAP JACK BUNNY HOPALL ABILITIES - WSSRA PARTICIPANTS & SIBLINGS TOO!
Celebrate the SPRING holidays with WSSRA & friends at our ALL YOU CAN EAT Pancake Breakfast and Bunny Hop. The building is accessible, bring the whole family & join the fun! Call in your reservation today at 847.455.2100.
Date: Saturday, April 9, 2011Time: 8:30-10:30 AMLocation: Ascension Church, Pine Room
601 Van Buren, Oak ParkFee: $1.00 per child 12 & under
$5.00 per person 13 & upRegistration Number: 195
Special EventsCOFFEE CARDS & CRAFTS
Beat the Winter Blues come out and make new friends, play games and enjoy a cup of coffee or two. Join us for one or all of these card shuffling Fridays.
Age: Older Adults, PI VI, MLH
REG. # DATE DROP OFF & PICK UP TIMES ACTIVITY DESTINATION FEE/TRANS
172-01 FridaysJan. 21, 2011
12:30 – 2:30pm Out with the old in with the new! Start the New Year crafting while enjoying a snack and coffee. End the program with a card game of Garbage and win a prize!
Franklin Towers, Franklin Park
$5.00/$6.05
172-02 Friday,Feb. 18, 2011
12:30 – 2:30pm Valentines Day is near! Make something special for that special someone while enjoying snacks and coffee. End the program with a card game of Garbage and win a prize!
Franklin Towers, Franklin Park
$5.00/$6.05
172-03 Friday, March 18, 2011
12:30 – 2:30pm Shamrock Shuffle! Shuffle your cards for a game of Garbage and add a little Irish trivia to the fun while snacking on Irish soda bread and drinking coffee.
Franklin Towers, Franklin Park
$5.00/$6.05
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REGISTRATIONAny cancellations for WINTER programs will be accepted through January 12, 2011 and credit will be issued. Any cancellations after January 12, 2011 participants will be charged full program fee. Any unpaid balance will restrict participation in future programs.
CLOSED PROGRAMSIf a program closes because we have reached maximum enrollment, you will be put on a waiting list and contacted if additional space is available.
CANCELLED PROGRAMSA. If four participants or less register, a program may be cancelled. A program reimbursement or credit will be issued.B. If a program is cancelled because of unforeseen circumstances you
will be contacted at the soonest possible time.C. A program credit will not be issued for weather related cancellations.
No programs will be made up unless otherwise specified.
REFUNDSRefunds will only be issued when the registrant cannot participate for extended medical reasons and/or hospitalization verified by a physician. For the majority of the season the refund/credit will be prorated. Call for more information. 847.455.2100.
PAYMENT POLICYPayment of program fees is due upon registration unless other arrangements are made. Statements are mailed out the first week of the program season (4 times per year). If changes are made in the registration (adding programs, cancelling programs) please call the office for your account balance as no other statement will be sent. Call the Finance Manager to arrange a payment plan, Monday through Thursday, 8:30 AM to noon. A participant cannot register for the next season until balance from previous season is paid.
RETURNED CHECK POLICYA $20.00 fee will be charged for any checks returned to WSSRA. The $20.00 fee, as well as the balance, will need to be paid before registering for future programs.
SCHOLARSHIP REQUESTWSSRA is in a position to offer scholarships to WSSRA residents for a percentage of fees for two programs each season. Persons requesting a scholarship must complete a scholarship application, which will be mailed to you upon request. Scholarship applications need to be filled out once a year. If you are interested in a scholarship, check the box on the registration form: Request Scholarship. All scholarship applications must be completed and in the WSSRA office by January 12, 2011.
NON-RESIDENT POLICYWSSRA programs are limited to people who live in the WSSRA partner districts and villages. If you live outside the WSSRA communities and are interested in participating in a special recreation program, call your park district or village recreation department. Call the WSSRA Outreach Specialists for more information.
PARTICIPANT ABSENCEIf you or your child are not going to attend a recreation program that you are registered for, please notify WSSRA office 847.455.2100 AS SOON AS POSSIBLE! Please leave a message on Voice Mail after hours.
PARTICIPANT ILLNESSFor the protection of all the participants in programs, you/your child must be kept at home or will be sent home if he/she shows any of the following symptoms:• A temperature of over 100.3.• Stomach ache accompanied by diarrhea or vomiting.• Any undiagnosed rash.• Sore or discharging eyes or ears.• Profuse nasal discharge (green or yellow). Please keep children with
active colds home.• Have a highly contagious condition such as chicken pox, measles,
lice, etc.
MEDICATIONIt is the parent/guardian and participant’s responsibility to inform WSSRA of any medication a participant is taking. This information is very important in case of an emergency. Medication information should be noted on the registration forms, as well as the Annual Information Form. Any changes in medication should be communicated to WSSRA.
INSURANCEThe Association takes every reasonable precaution to prevent injuries and accidents from occurring. However, if an accident does occur or if you or your child is injured, you are solely responsible for any costs incurred or caused by an injury that happens in an Association program.
SAFETY PRECAUTIONSSome participants in WSSRA programs and special events may be carriers of infectious disease(s). Staff and volunteers have been provided in-service training concerning proper hygienic procedures. WSSRA seeks to provide a safe environment for all of our participants, staff volunteers and the public. If you have any specific questions, please call the WSSRA Executive Director or Superintendent of Safety & Operations at 847.455.2100.
REVISED LATE PICK-UP/DROP-OFF POLICYIn order to be fair to our participants, program staff and drivers, WSSRA has enacted a Late Pick-up/Drop-off Policy. Many of our program staff and drivers need to get to a program immediately after the program your child is in. We ask that you make sure you are on time picking up your child from program, as well as home to greet your child when the WSSRA van drops them off.
A $10.00 fee will be charged for every 15 minutes or portion thereof, a participant is picked up late, or a van is delayed, after a 10 minute grace period. A notice will be sent to you indicating the fee being charged to your account.
Also, participants must be dropped off on time for programs that are traveling, including over night trips. Vans will not wait more than 5 minutes for participants who are late for the program.
Saturday morning programs - Parents must drop off their child by 9:30 AM or call the emergency phone. If the program is traveling, the van will not wait longer than 5 minutes past the program start time.
WSSRA Program Policies
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WSSRA TRANSPORTATION1. Door to door transportation is available for all programs noted with
the transportation symbol. This extra service is available if you pay a $6.05 per round trip fee, for each day the program meets.
2. Transportation to programs from designated pick up points is available for a fee of $2.75 per round trip, for each day the program meets. You must pay at time of registration.
3. All participants being transported in WSSRA vehicles must abide by WSSRA guidelines. Failure to do so will result in suspension from transportation. Repeat offenders will not be transported by WSSRA.
4. Parents or participants must notify the Association in regard to any change in transportation.
5. If an Association vehicle cannot complete a route and family members must pick up riders, a credit will be issued for the participant’s later use.
6. Any registration received after January 12, 2011 may result in a late program start or no transportation.
7. Parents are requested to notify their child’s school on days students are being picked up by a WSSRA van.
8. A participant under the age of 16 must be taken off the van by a responsible person over 12 years old.
PLAYING IT SAFEDue to new state legislation, car seats or booster seats must be provided for all children ages seven and under. For more information contact Bob Foster.
WAIVER OF LIABILITYWSSRA is insured through a self insurance pool with other Special Recreation Associations and Park Districts. Our pool is known as the Park District Risk Management Agency (PDRMA). As a loss prevention measure, PDRMA is requiring participants to execute a release of liability for programs. The reverse side of the registration forms contains the WSSRA waiver release form. This must be signed and returned to the WSSRA office before participants can be in programs.
Since we do not carry medical or accident insurance for program participants, the release of liability is necessary. The cost of such coverage would make our program fees too high for most to afford. Please review your personal health plan to be certain that you and your family have coverage in instances like these.
Our objective is to offer a high quality program at a reasonable cost. The use of a release of liability when appropriate is but one way we are trying to meet that objective. If you have any questions, call Sandra Gbur at 847.455.2100. We appreciate your continued involvement and support.
WALK-IN OR MAIL-IN OR FAXED REGISTRATION PROCEDURES1. Complete the enclosed registration form with correct program
selection, day, program fee, transportation and payment option. 2. Contact your local park district or village for use of their fax machine
to fax your registration.3. All signed registration forms received by January 12, 2011 will be
processed by the WSSRA Registrar and approved for program and transportation information.
4. All registrations will be accepted on a first-come, first served basis until we reach our maximum enrollment for each program.
5. Mail-in or walk-in registrations received AFTER 5:00 PM January 12, 2011 may result in a late program start and transportation may not be available.
6. If a program closes, you will be put on a waiting list and contacted if openings are available.
7. Recreation Specialists MAY NOT accept program payment or registration forms at programs. This must be done by mail or at the office only.
8. Anyone registering MUST have a working phone number.9. A participant cannot register for the next season until balance from
previous season is paid.
PHONE-IN REGISTRATION PROCEDURES ONLY1. Phone-in registration begins December 13, 2011 and will be
accepted until January 12, 2011. Any mail-in and faxed registrations received prior to December 13, 2011 will be processed in the order they are received).
2. Calls will be accepted Monday through Friday from 9:00 until 1:30 PM.3. The WSSRA Registrar will assist you in completing the registration
form. She will be sure the programs selected are age and ability appropriate.
4. A confirmation letter will be sent to you. Sign the attached waiver form and return to WSSRA by January 12, 2011 .
5. The registration will be on hold until we receive the signed registration form. No participation can take place without this signature.
6. Phone-in registration WILL NOT BE ACCEPTED after January 12, 2011 .7. Faxed, mail-in or walk-in registrations will be accepted after
January 12, 2011 but may result in a late program start and transportation may not be available.
8. All registrations will be accepted on a first-come, first-served basis until we reach our maximum enrollment for each program.
9. If a program closes, you will be put on a waiting list and contacted if openings are available.
10. Recreation Specialists MAY NOT accept program payment or registration forms at programs. This must be done by mail or at the office only. We can accept credit card payments over the phone during business hours.
11. Anyone registering MUST have a working phone number.12. A participant cannot register for the next season until balance from
previous season is paid.
WINTER 2011 REGISTRATION FORMMAIL TO: WSSRA, 2915 Maple Street, Franklin Park, IL 60131 FAX TO: 847.455.2157 SIGNED REGISTRATION MUST BE RECEIVED BY JANUARY 12, 2011
Participant’s Name: ________________________________________________ Birth Date: _____________________
Address: ________________________________________________ City/State: ________________________ / ________ Zip: __________________________
Park District/Village: ________________________________________________ Home Phone: _____________________________________________________
Parent Or Guardian Name: _________________________________________________ E-Mail: ___________________________________________________
Parent/Guardian Work Phone: ______________________________________ Parent/Guardian Cell Phone: ____________________________________
Who Should We Contact If Parent/Guardian Is Unavailable? Name: ___________________________________ Phone: _________________________
Doctor’s Name: _________________________________________________ Doctor’s Phone: ________________________________
Present School/ Workshop/Other: _____________________________________________________________________________________________________
Teacher/Supervisor Name: __________________________________________ Dismissal Time: ___________________________________________________
Participant’s Disability: ________________________________________________________________________________________________________________
Can Participant Transfer? □Yes □No Does Participant Use Wheelchair/Walker? Specify: _________________________________________________
Is Participant Subject To Seizures: □Yes □No List Any Medication: _______________________________________________________________________
Is Medication Taken At Program? □Yes □No
List Any Allergies: _____________________________________________________________________________________________________________________
Does Participant Have A Communicable Disease? □Yes □No If Yes, Please Explain ______________________________________________________
______________________________________________________________________________________________________________________________________
Program # Program Name Day Fee TranspSubtotal
Program & Transport FEES
TOTAL DUE:FEE PAYMENT OPTION - CHECK ONE□ Total Payment Enclosed□ Total Payment to Follow (if FAXED)□ Request Scholarship□ Payment Plan – Arranged with Finance Manager□ Credit Card □ Visa □ Master Card □ Discover Exp. Date: ______________ Card Number:
COMMENT SHEET – WE WELCOME YOUR INPUT!We invite you to share with us your program ideas and comments about our services:______________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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West Suburban Special Recreation Association
WAIVER RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT(Read Carefully)
Please read this form carefully and be aware that in signing up and participating in West Suburban Special Recreation Association programs, you will be waiving and releasing all claims for injuries arising out of these programs that you or the named participant might sustain. The terms “I”, “me” and “my” also refer to parents or guardians as well as participants in the programs. In registering for these programs, you are agreeing as follows:
As a participant in these programs, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I may sustain as a result of participating in any manner, in any and all activities connected with or associated with such activities and involve substantial risks of injury.
I agree to waive and relinquish any and all claims I may have as a result of participating in these programs against the West Suburban Special Recreation Association, any and all participating governmental units, any and all independent contractors, officers, agents, servants and employees of the governmental bodies and independent contractors, and any and all other persons and entities of whatever nature that might be directly or indirectly liable for any injuries, that I might sustain while participating in these programs.
I do hereby fully release and discharge the West Suburban Special Recreation Association and the other released parties from any and all claims for injuries, damages or loss, which I may have or which may accrue to me on account of my participation in these programs.
I further agree to indemnify, hold harmless and defend, the West Suburban Special Recreation Association and any and all other parties from any and all claims resulting from injuries, damages and losses sustained by anyone, and arising out of, connected with, or in any way associated with my conduct and the activities of these programs.I further understand and agree that the terms such as “participation”, and “activities”, referred to in this Agreement, include all exercises and physical movements of any nature while I am participating in these programs and further include the provision, of or failure to provide proper instructions or supervision, the use and adjustment of any and all machinery, equipment, and apparatus, and anything related to my use of the services, facilities, or premises, involved in these programs, and transportation to and from events.
I understand the nature of these programs for which I am registering, and have read and fully understand this Waiver, Release and Hold Harmless Agreement. I further understand that any advisement or warnings of the particular risks of these programs that I subsequently receive will be incorporated by reference into and become a part of this Agreement.
In case of emergency, I give my permission for the participant to receive any first aid, transportation or medical attention that may be required.
You may return this waiver and release of all claims by mail or fax. You may mail this release to 2915 Maple St., Franklin Park, IL 60131 or send by facsimile transmission to 847.455.2157. When forwarding by fax, it is mutually understood that the facsimile document shall substitute for and have the same legal effect as the original form.
To Communicate with School/Health Care Personnel*I authorize councelors, teachers, case workers, therapists, or physicians to communicate with WSSRA about the participant’s needs as they relate to WSSRA’s provision of recreation services to the participant. WSSRA will keep confidential all information obtained through such communications.□ yes □ no
To Disclose Information to WSSRA Member Partners*WSSRA may disclose to my home park district or municipality information about the participant’s and my involvement in WSSRA programs or activities, including our names, telephone number, address, program registrations, and the participant’s age and disability, provided that my home park district or municipality shall not redisclose that information without my express written consent. □ yes □ no
To Release Information for Publicity Purposes*I authorize the use of photographs or descriptions of the participant or of me in publicity materials about WSSRA programs and services, which may appear in newspapers, member partner brochures, video presentations, web sites and other similar mediums or displays.□ yes □ no*I understand that I can change my decisions regarding the statements above at any time for any reason by delivering a written notice to WSSRA, prohibiting further disclosure information.
___________________________________________________ ___________________________Parent/Participant/Guardian Signature Date
West Suburban Special Recreation Association2915 Maple Street | Franklin Park, Il 60131P 847.455.2100 | F 847.455.2157www.wssra.net
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