REGISTRATION DATES
RESIDENT ONLY - PRIORITY • MAY 4 - MAY 8
RESIDENT/NON-RESIDENT/CO-OP • MAY 11 - MAY 15
A Letter from the Executive Director
Dear SWSRA family & friends,
As the warm days of summer approach, we are excited to welcome you to another fun-filled season with SWSRA! Our summer brochure is packed with a wide variety of programs, special events, and opportunities designed to bring joy, build friendships, and create lasting memories for participants of all ages and abilities.
At SWSRA, we are committed to providing inclusive, engaging, and high-quality recreational experiences. Whether you are returning for your favorite programs or trying something new, our dedicated staff is here to support each participant in having a safe, successful, and enjoyable summer.
This season, we are especially excited to offer activities for all ages including creative arts, social gatherings, and communitybased activities. SWSRA is especially excited to offer an overnight adventure for adults to Indianapolis. Summer is the perfect time to explore new interests, stay active, and connect with friends—both old and new.
We encourage you to review the brochure carefully, mark your calendars, and register early, as programs tend to fill quickly. If you have any questions or need assistance selecting programs, our team is always happy to help guide you. Be sure to check out some of these highlighted programs below:
Early Childhood & Youth
• Basketball Skills & Drills
Teen & Adult
• Painter's Club is back!
• Boards & Bags
• Pickleball
Overnight Trip
• Indianapolis, IN
Thank you for being a valued part of the SWSRA community. We look forward to sharing a wonderful summer with you!
Warm regards,
Nicolette D. Lahman-Morales Executive Director
Who We Are
South West Special Recreation Association (SWSRA) is comprised of member districts that include: Alsip Park District, Blue Island Park District, Hickory Hills Park District, Village of Merrionette Park, Midlothian Park District, Palos Heights Parks & Recreation Department, Posen Park District, and Worth Park District.
SWSRA was formed in 1981 to provide yearround quality therapeutic recreation programs and services for individuals with intellectual and/or physical disabilities. SWSRA offers a wide variety of programs for individuals in early childhood through adulthood. These programs are designed to increase independence and enhance the quality of life for each individual. SWSRA works to provide an inclusive environment which allows the participants to thrive in recreational settings with their peers.
This includes but is not limited to individuals who have varying degrees of physical or mental disabilities, learning disabilities, behavior disorders, and hearing or visual impairments.
MISSION STATEMENT
Our mission is to serve individuals with disabilities in their need for recreation so that all persons in our member communities may experience and enjoy positive leisure opportunities.
VISION STATEMENT
SWSRA will be the leading community-based provider of quality therapeutic recreation programs for individuals with disabilities and consistently set new standards of value to meet the changing needs of our participants and our member communities.
ADMINISTRATION & RECREATION TEAM
Nicolette D. LahmanMorales Executive Director nlahman@swsra.com 708-389-9423 ext. 204
Patti Swiney Business Manager
pswiney@swsra.com 708-389-9423 ext. 203
Marina Uher, CTRS, CPRP Superintendent of Recreation muher@swsra.com 708-389-9423 ext. 208
BOARD OF DIRECTORS
Alsip Park District
Jeannette Huber
Blue Island Park District
Ted Ruthenberg Hickory Hills Park District
Renee Chavez
Merrionette Park Michelle Higgins
CONTACT US
Ami Ill, CTRS Program Manager aill@swsra.com
708-389-9423 ext. 210
Brittany Izzo, CTRS Program Manager bizzo@swsra.com
708-389-9423 ext. 207
Tina Izzo-Delbovo Recreation Specialist tizzo-delbovo@swsra.com
708-389-9423 ext. 212
Main Office Clerk info@swsra.com
708-389-9423 ext. 201
Midlothian Park District
Ed Jung
Palos Heights Parks & Recreation Department
Matt Fairbanks
Posen Park District T.J. Whitcomb
Worth Park District
Robert O’Shaughnessy
SWSRA Main Office 12521 South Kostner Avenue, Alsip, IL 60803
Phone: 708-389-9423
Fax: 708-389-6458
Website: www.swsra.org
FOLLOW US
Facebook: South West Special Recreation Association (SWSRA)
Instagram: @we_are_swsra
Twitter: @SWSRA
Registration
PROGRAM DATES
June 8 - August 8
REGISTRATION DATES
Residents Only - Priority Registration*
May 4 - May 8
Resident/Non-Resident/Co-Op Registration
May 11 - May 15
*Please keep in mind our space is limited and in high demand.We encourage residents to enroll during this priority period. Registration will be processed on a first-come, firstserve basis.
Any registration that is received prior to your specific registration week will be processed on the second business day of your designated registration week.
HOW TO REGISTER
Complete your registration form and submit the form with payment one of the following ways:
Email: info@swsra.com
Mail: 12521 S. Kostner Ave., Alsip, IL 60803
Fax: 708-389-6458
Drop Off: During regular business hours: Monday - Friday, 10:00am-4:00pm.
PARTICIPATION AGE GUIDE
To help select the appropriate program for yourself/ child, please use this guide to assist you. Please note that some of these may overlap due to cognitive level variations. SWSRA staff may determine appropriate placement if necessary.
Early Childhood (EC): Ages 3-7
Youth: Ages 8-12
Teen: Ages 13-17
Adult: Ages 18 & Up
AMERICANS WITH DISABILITIES ACT
SWSRA is subject to and will comply with the Americans with Disabilities Act (ADA), which prohibits discrimination on the bases of disability against persons who meet essential eligibility requirements for services. If you have any questions about our services in regard to the ADA, please call us at 708-389-9423.
PROGRAM & SPECIAL EVENT ICONS
SWSRA offers a variety of programming and special events. We have included icons within the brochure to help differentiate the types of programs and special events. The icons are located next to the program and special events titles.
Virtual Program
In-Person Program
Transportation Available
SWSRA PROGRAM LOCATION(S)
Alsip Park District - Apollo 12521 S. Kostner Avenue Alsip, IL 60803
Burr Oak Bowl 3030 W. 127th Street Blue Island, IL 60406
Centennial Park
Aquatic Center 15600 West Avenue Orland Park, IL 60462
Emagine Frankfort 19965 LaGrange Road Frankfort, IL 60423
Goy Building
10707 S. Oak Park Avenue Worth, IL 60482
Midlothian Park District 14500 Kostner Avenue Midlothian, IL 60445
Ozinga Field 14011 Kenton Avenue Crestwood, IL 60445
Romeoville Recreation Center 900 W. Romeo Road Romeoville, IL 60446
South Suburban Special Recreation Association 19910 80th Avenue Tinley Park, IL 60487
Agreements
Information & Cooperative
MASTER REGISTRATION FORM
SWSRA requires all participants to complete a Master Registration Form annually. The form provides staff with valuable information, which allows SWSRA to conduct its activities in the safest possible manner and to meet the basic needs of participants. If you are new to SWSRA or do not have a current form on file, please contact the office and one will be sent to you. Additionally, if the agency receives a registration form and does not have a Master Registration Form on file, one will be sent to you to complete and return. If at any time the form needs to be updated (change in medication, behavior, address, house manager, etc.) please call the SWSRA office. All information is kept strictly confidential and enhances successful participation.
PARTICIPANT ASSESSMENT
We assess each of our “new” participants for all our programs to best fulfill their needs and goals. Once you enroll in a SWSRA program, someone from the recreation staff will contact you within 2 weeks to complete an over-the-phone assessment. The goal of this interview is to get to know your participant and be able to train our Team to work with them.
STAFF RATIO
SWSRA currently staffs most programs with one staff to every four participants. If a participant will need more assistance or won't be able to participate within this structure, please let staff know at registration so appropriate staffing may be secured (if possible). Please note in brochure write ups any exceptions to this 1:4 ratio.
INCLUSION
SWSRA is committed to providing new and challenging leisure and recreation activities for all our participants. We recognize that a park district or recreation department program may better serve an individual’s needs. SWSRA works with our partner agencies to assist individuals with making the transition from special recreation to these programs. Our professional staff can help you choose an appropriate program, provide referral services, conduct any necessary staff training, secure support staff, or supply adaptive equipment or communication devices. If you or a family member wish to participate in a park district or recreation department program, please contact our office.
LINCOLNWAY SPECIAL RECREATION ASSOCIATION COOPERATIVE AGREEMENT
A cooperative agreement with the Lincolnway Special Recreation Association (LWSRA). Each association offers programs to the other association’s residents at indistrict rates with the following exceptions:
1. Special Services - scholarships & door to door transportation are not included. First Time Participant Discount does not apply to LWSRA residents.
2. Participants who wish to register for TITANS, summer camp, vacation trips, away camps and weekend trips may do so at non-resident rates.
3. Early bird discounts or any other discounts do not apply under this agreement.
4. When programs are offered free to either association’s own residents because of grant funds or sponsorships, the program or event will be offered to residents of the other association at the regular fee for residents.
All other agency policies and guidelines apply to residents who register for programs under this Agreement. LWSRA serves the residents of: Crete, Frankfort, Frankfort Square, Mokena, Manhattan, New Lenox, Peotone, and Wilmington.
SOUTH SUBURBAN SPECIAL RECREATION ASSOCIATION COOPERATIVE AGREEMENT
A cooperative agreement with South Suburban Special Recreation Association (SSSRA). Each association offers programs to the other association's residents at indistrict rates with the following exceptions:
1. Special Services such as scholarships, door to door transportation, and “First Time Participant Discounts” are not included in this agreement.
2. Participants who wish to register for day camps, vacation trips, away camps and weekend trips may do so at non-resident rates.
3. Early bird discounts or any other discounts do not apply under this agreement. Registration for programs will take place after the deadline is reached for “regular” agency residents. Registrations will then be taken on a first-come, first-serve basis.
4. When programs are offered free to either association’s own residents because of grant funds or sponsorships, the program or event will be offered to residents of the other association at the regular fee for residents.
All other agency policies and guidelines apply to residents who register for programs under this agreement. The intent is not to duplicate services. Therefore, if an agency offers similar programs as the home agency the participant can participate but at the non-resident rate. SSSRA serves the residents of: Country Club Hills, Hazel Crest, HomewoodFlossmoor, Lan-Oak, Matteson, Oak Forest, Olympia Fields, Park Forest, Richton Park, Tinley Park.
Virtual Programs
VIRTUAL RECREATION PROGRAMS
Virtual Recreation will bring programs right to you and your family in order for you to stay inspired, connected and creative. You will receive an email with the links the Friday prior to the season starting.
SWSRA uses Zoom Video Communications as the platform to run virtual programs. You will need to make sure you have a stable connection to the internet, a good headset for either your computer or phone, minimal background noise and minimal distractions in order to have a successful program(s).
Group: Teens & Adults
Dates: June 8-August 8
No Programs June 29-July 3; July 31
Fee: $45
Weekly Schedule
Coffee Talk Monday 9:00am-9:30am
BINGO Monday 4:00pm-4:30pm
Lunch with Friends Wednesday 11:30am-12:00pm
Games Galore Wednesday 4:00pm-4:30pm
Coffee Talk Friday 9:00am-9:30am
BINGO Friday 4:00pm-4:30pm
Virtual Recreation Programs Description
BINGO: Who doesn't like a good game of BINGO? Each BINGO game winner will have their name entered into a drawing at month end. The more times you win, the greater chance you have for winning the overall seasonal prize.
Coffee Talk: Grab your favorite morning beverage (water, tea, coffee, juice, etc.) and begin your morning talking with your peers.
Games Galore: Each week we will explore a new fun game to play!
Lunch with Friends: Bring your lunch and socialize with your friends. We will discuss current events, video games, movies and much more!
VIRTUAL CLUB
You will receive an email with the links the Friday prior to the season starting.
Bakers Club
Have a sweet tooth and are interested in learning a new recipe each week? During this program, bakers will learn a new recipe step by step to share with others! Recipes will be cut in half to make a smaller treat at home.
Group: Teens & Adults
Day: Saturday
Dates: June 20, July 11, August 1
Time: 10:00am-11:00am
Fee: $40 (R), $50 (NR)
BOWLING
Do you want to have a “striking” good time with your friends at the alley? Bowling with SWSRA gives you that opportunity to have fun and be with your friends at the same time! Our bowling program provides a chance for all ability levels to participate in this fantastic sport. Please note the numbers next to each option. This is how you will sign up on the registration page.
Programs swsra a
Fee includes: one or two game(s) of bowling, shoe rental, one t-shirt per year, and staff supervision
As soon as bowlers are finished with all of their games, they are free to go home with a designated guardian. Occasionally, games move quickly and may cause some bowlers to be done before 6:00pm.
Group: Youth, Teens & Adults
Day: Wednesday
Dates: June 10-August 5
No Programs July 1
Time: 5:00pm-6:00pm
Location: Burr Oak Bowl, Blue Island
Youth Bumper Bowl
Min/Max: 3/6
Fee: $130 (R), $255 (NR)
Bowling I
Min/Max: 4/8
Fee: $130 (R), $255 (NR)
Bowling II *
Min/Max: 4/8
Fee: $165 (R), $325 (NR)
*Participants in Bowling II get two (2) games of bowling and must be able to bowl at a pace which would allow the lane of four (4) bowlers to complete both games in the allotted hour time frame.
SPECIAL OLYMPICS COYOTES BOWLING
Join us to practice for the Special Olympics tournament! Only participants enrolled in this program will be eligible to compete in the Special Olympics Region E tournament. Bowlers of all skill levels—from beginners to advanced—are welcome. Additional fees will be required if the bowler qualifies for State Competition.
Fee includes: two games of bowling, shoe rental, one, t-shirt per year and staff supervision during weekly program and region and sectional tournament only.
Group: Teens & Adults
Day: Wednesday
Dates: June 10-August 5
No Programs July 1
Region E Tournament Date: August 8
Time: 5:00pm-6:00pm
Location: Burr Oak Bowl, Blue Island
Min/Max: 4/8
Fee: $175 (R), $350 (NR)
PAINTERS CLUB
Create a new masterpiece each week with easy-to-follow, step-by-step guidance, including instruction on how to mix the colors needed for each painting.
Fee includes: instruction, supplies, and staff supervision.
Group: Teens & Adults
Day: Monday
Dates: June 8, June 22, July 6, July 20
Time: 5:30pm-7:00pm
Location: Goy Building Worth
Min/Max: 4/8
Fee: $90 (R), $115 (NR)
Programs
BOARDS & BAGS
Step up to the boards and join the fun! Boards & Bags is a relaxed and social program where participants can learn the basics of cornhole, practice their aim, and enjoy friendly competition. Whether you’re new to the game or looking to sharpen your skills, this program offers a welcoming environment for all ability levels.
Fee includes: staff supervision.
Group: Teens & Adults
Day: Tuesday
Dates: June 9-July 28
No Programs June 30
Time: 5:00pm-6:00pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $70 (R), $90 (NR)
BASKETBALL SKILLS & DRILLS
Get ready to dribble, pass, and shoot! This program focuses on building essential skills through fun drills and games, helping players improve while enjoying the game and taking their abilities to the next level.
Fee includes: supplies and staff supervision.
Group: EC & Youth
Day: Thursday
Dates: July 9-July 30
EC Time: 4:30pm-5:15pm;
Youth Time: 5:15pm-6:00pm
Location: Alsip Park District-Apollo, Alsip
Min/Max: 3/6
Fee: $45 (R), $60 (NR)
SOCIALITES
We do a wide variety of exciting social activities and outings in the community that you don't want to miss. Sign up early because this program is popular!
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Fee includes: supplies, transportation and staff supervision.
Group: Adults
Day: Thursday
Dates: June 11, June 25, July 9, July 23
Time: 6:30pm-8:30pm
Location: Meet at Alsip Park District-Apollo, Alsip
Min/Max: 4/8
Fee: $155 (R), $310 (NR)
Pick Up: Alsip Park District-Apollo 8:45pm
PICKLEBALL
Pickleball has become a big dill and is a fun and fast-growing sport, combining elements of tennis, badminton, and ping-pong, offering a unique and engaging experience for players of all ages and skill levels
Fee includes: equipment and staff supervision.
Group: Teens & Adults
Day: Friday
Dates: June 12-August 7
No Program June 26 & July 3
Time: 6:00pm-7:00pm
Location: Alsip Park District-Apollo, Alsip
Min/Max: 4/8
Fee: $80 (R), $95 (NR)
Special Events
STEP IT OUT
Turn up the music and let’s step it out to “Just Dance” for our morning work out. After our workout we will have a healthy snack. Participants must wear gym shoes and are encouraged to bring a filled water bottle.
Fee includes: snack, supplies, and staff supervision.
Group: Teens & Adults
Day: Saturday
Date: June 13
Time: 10:00am-11:30am
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $25 (R), $35 (NR)
Registration Deadline: May 29
WINDY CITY THUNDERBOLTS GAME
Hit it out of the park! We are headed to Ozinga Field to watch the Windy City Thunderbolts play the Lake Erie Crushers. After the game we will stay to watch the fireworks show! Participants are encouraged to bring money for the concession stands and wear gym shoes.
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Fee includes: ticket, transportation and staff supervision.
Group: Adults
Day: Saturday
Date: June 13
Time: 4:30pm-10:00pm
Location: Meet at Alsip Park District-Apollo, Alsip
Min/Max: 4/8
Fee: $80 (R), $160 (NR)
Registration Deadline: May 15
VANILLA MILKSHAKES & GAMES
Today is national vanilla milkshake day! Let’s work in the kitchen to make a tasty milkshake to enjoy while playing a variety of game
Fee includes: snack, supplies, and staff supervision.
Group: Teens
Day: Saturday
Date: June 20
Time: 2:00pm-3:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $25 (R), $35 (NR)
Registration Deadline: June 5
FRIDAY NIGHT LIGHTS
Show your team spirit and hit the dance floor! Come dressed in your favorite sports team gear and celebrate with your SRA friends as we dance the night away, representing the teams we love. It’s going to be a night full of energy, fun, and team pride— don’t miss it!
Fee includes: DJ, snack, and staff supervision.
Group: Teens & Adults
Day: Friday
Date: June 26
Time: 7:00pm-9:00pm
Location: Midlothian Park District, Midlothian
Min/Max: 8/12
Fee: $15 (R), $20 (NR)
Registration Deadline: May 29
SENSORY SUMMER
Join us for a hands-on sensory event where participants will explore a variety of engaging stations that spark creativity and stimulate the senses.
Fee includes: supplies and staff supervision.
Group: EC & Youth
Day: Saturday
Date: June 27
Time: 1:00pm-2:30pm
Location: Goy Building, Worth
Min/Max: 3/6
Fee: $25 (R), $35 (NR)
Registration Deadline: June 12
Special Events
ICE CREAM CAKE CREATION
Let’s celebrate national ice cream cake day by making individual ice cream cakes to bring home! While our chocolate cakes are in the oven we will make homemade whipped cream to top our cakes.
Fee includes: supplies and staff supervision.
Group: Adults
Day: Saturday
Date: June 27
Time: 3:30pm-5:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $35 (R), $45 (NR)
Registration Deadline: June 12
NWCSRA HAWAIIAN LUAU DANCE
Aloha friends! Join your SRA friends at this luau event with your Hawaiian attire. There will be fun music to dance to and a full dinner to enjoy!
Fee includes: admission, dinner, transportation* and staff supervision.
Group: Teens & Adults
Day: Friday
Date: July 10
Time: 6:00pm-8:30pm
Location: Romeoville Recreation Center, Romeoville Min/Max: 4/8
Fee with Transportation: $80 (R), $160 (NR)
Fee without Transportation: $65 (R), $130 (NR)
*Meet at Romeoville Recreation Center
Registration Deadline: June 12
WITH TRANSPORTATION
Meet at Alsip Park District-Apollo: 5:00pm
Pick up at Alsip Park District-Apollo: 9:15pm WITHOUT TRANSPORTATION
Meet at Romeoville Recreation Center: 6:00pm
Pick up at Romeoville Recreation Center: 8:30pm
LOADED FRIES
Did you know today is national french fry day? Get ready to get in the kitchen to make homemade fries. While our fries bake we will prepare chicken, BBQ pulled pork and cheese to top our fries with.
Fee includes: dinner, supplies and staff supervision.
Group: Adults
Day: Saturday
Date: July 11
Time: : 5:30pm-7:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $35 (R), $45 (NR)
Registration Deadline: June 26
PIZZA AND MOVIE NIGHT
Get ready to make your own personal pizza for dinner! We will watch “Percy Jackson & the Olympians: The Lightning Thief". We will finish off the night making lightning cookies to eat.
Fee includes: dinner, supplies and staff supervision.
Group: Teens
Day: Friday
Date: July 17
Time: : 6:00pm-8:00pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $30 (R), $40 (NR)
Registration Deadline: July 2
STONE OWLS
Join us for a hootin’ good time! We will make outdoor stones into two owls that you can decorate your yard with! While our stone owls dry, we will make an owl decorated snack.
Fee includes: dinner, supplies and staff supervision.
Group: Teens & Adults
Day: Saturday
Date: July 18
Time: 1:00pm-3:00pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $40 (R), $50 (NR)
Registration Deadline: July 2
Special Events
SCIENCE QUEST
Step into a world of discovery! Young scientists will explore, experiment, and uncover the magic of science. This will be a fun and interactive day.
Fee includes: supplies and staff supervision.
Group: EC & Youth
Day: Saturday
Date: July 25
Time: 10:00am-11:00am
Location: Goy Building, Worth Min/Max: 3/6
Fee: $20 (R), $25 (NR)
Registration Deadline: July 10
BADA-BINGO
Get ready for some BINGO fun! We will play several rounds of BINGO. Everyone will receive a prize for joining us! After playing BINGO we will cool down from the summer heat with an ice cream soda float.
Fee includes: snack, supplies, and staff supervision.
Group: Teens & Adults
Day: Saturday
Date: July 25
Time: 1:00pm-2:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $25 (R), $35 (NR)
Registration Deadline: July 10
CENTENNIAL PARK AQUATIC CENTER
Summer is in full swing! We are headed to Centennial Park Aquatic Center in Orland Park to cool off and relax at the pools. We ask that participants eat lunch prior to the program and come with their swimsuit on and sunscreen applied. Participants can bring money for concessions. Outside food and drinks are not allowed into the facility.
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Fee includes: snack, supplies and staff supervision.
Group: Adults
Day: Sunday
Date: July 26
Time: 12:15pm-4:15pm
Location: Meet at Alsip Park District-Apollo, Alsip Min/Max: 4/8
Fee: $90 (R), $180 (NR)
Registration Deadline: July 10
EXPERIMENT ZONE
Get ready to mix, test, and discover! This interactive science program invites young scientists to conduct a range of cool experiments. With hands-on activities and plenty of “wow” moments, participants will build curiosity, creativity, and confidence in science. We will finish off the program with a rootbeer float!
Fee includes: snack, supplies, and staff supervision.
Group: Teens
Day: Saturday Date: August 1
Time: 1:00pm-2:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $25 (R), $35 (NR)
Registration Deadline: July 17
Special Events
CHEDDAR, BACON AND CHICKEN MELT SANDWICH
This recipe will make you want to melt. We are working in the kitchen to make a cheddar, bacon and chicken melt sandwich on sourdough. We will serve chips for a side with our sandwiches.
Fee includes: supplies and staff supervision.
Group: Adults
Day: Saturday
Date: August 1
Time: 5:30pm-7:30pm
Location: Goy Building, Worth
Min/Max: 4/8
Fee: $35 (R), $45 (NR)
Registration Deadline: July 17
MOVIE MAGIC
Set sail with us for a summer evening of Moana. This is the perfect night to create crafts, enjoy a snack, and watch a great movie.
Fee includes: snack, supplies and staff supervision.
Group: EC & Youth
Day: Friday
Date: August 7
Time: 5:00pm-7:00pm
Location: Goy Building, Worth
Min/Max: 3/6
Fee: $25 (R), $35 (NR)
Registration Deadline: July 24
AFTERNOON MOVIE
Join us as we head out to see Spider-Man: Brand New Day! We’ll be traveling to Emagine Frankfort for a late afternoon showing of this exciting movie adventure. Participants are welcome to bring money if they would like to purchase snacks during the film.
Fee includes: movie ticket, transportation and staff supervision
Group: Adults
Day: Saturday
Date: August 8
Time: Families will be called the Wednesday before with the event time.
Location: Meet at Alsip Park District-Apollo, Alsip Min/Max: 4/8
Fee: $65 (R), $130 (NR)
Registration Deadline: July 24
SSSRA MOVIE UNDER THE STARS
Summer is winding down, so join your SRA friends for a fun outdoor movie night! Participants are encouraged to bring a bag chair or blanket for seating. A snack and water will be provided. Movie of the Night: Cars.
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Fee includes: admission, snack, and staff supervision.
Group: Teens & Adults
Day: Friday
Date: August 21
Time: 6:45pm-10:30pm
Location: Meet at Alsip Park District-Apollo, Alsip
Min/Max: 4/8
Fee: $65 (R), $100 (NR)
Registration Deadline: July 24
OVERNIGHT TRIP
We are headed on a fun-filled trip to Indianapolis, IN. We will dive into racing history at the iconic Indianapolis Motor Speedway Museum, play classic games at Pins Mechanical Company, and explore the amazing animals at the Indianapolis Zoo. This is an action-packed getaway full of memories waiting to be made.
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Staff will not be sleeping in the same hotel room as participants. SWSRA will not provide supervision of the participants after "lights out". Participants are expected to be able to function independently during that period
Group: Adults
Day: Monday-Wednesday
Date: August 31-September 2
Min/Max: 4/8
Fee: $785 (R), $985 (NR)
$350 deposit due July 31; remaining balance due August 14
Registration Deadline: July 31
Overnight Trip to Overnight Trip to Indianapolis, IN. Indianapolis, IN.
SWSRA is headed on a fun-filled trip to Indianapolis, IN. We will dive into racing history at the iconic Indianapolis Motor Speedway Museum, play classic games at Pins Mechanical Company, and explore the amazing animals at the Indianapolis Zoo. This is an action-packed getaway full of memories waiting to be made.
Participants must be able to participate at a 1:4 staff to participant ratio and have independent ADL (Activity of Daily Living) skills. South West Special Recreation Association reserves the right to determine if this program is appropriate for an individual. Appropriate behaviors must be demonstrated so as not to distract from another participant's experience.
Staff will not be sleeping in the same hotel room as participants. SWSRA will not provide supervision of the participants after "lights out". Participants are expected to be able to function independently during that period.
Group: Adults
Dates: Monday, August 31-Wednesday, September 2
Fee: $785 (R) $985 (NR)
$350 Deposit due Friday, July 31
Remaining balance due Friday, August 14
Recreation Boxes
LEMON SERVING TRAY
Bring a splash of sunshine to your décor with this cheerful lemon-inspired serving tray! This craft is intended to style a tabletop. Please note: for decorative use only-not intended for food serving. Supplies include: 15” wooden half circle, handles, paint, paint brushes, mod podge, and sponge brush.
Group: All
Fee: $25
Delivery (Residents ONLY): $5
Registration Deadline: May 22
Pick up & Delivery Date: May 29
Pick up Location: SWSRA Main Office
Delivery: Date listed above, time will be between 10:00am-11:00am
SUMMER TOTE
Create your own go-to summer accessory with this tote bag. Designed for creativity and everyday use. This is a hands-on project that is functional and fun. Supplies include: tote bag, stencil, and acrylic markers.
Group: All
Fee: $20
Delivery (Residents ONLY): $5
Registration Deadline: May 22
Pick up & Delivery Date: May 29
Pick up Location: SWSRA Main Office
Delivery: Date listed above, time will be between 10:00am-11:00am
Pictures below are of the summer recreation boxes.
OASIS Adult Day Program
SWSRA'S Adult Day Program
OASIS was created to meet the needs of individuals with disabilities ages 18 and older. This is a structured program designed to help increase independence in a variety of areas that help foster personal growth of each individual.
General program goals are to provide quality recreation services as well as increase and maintain social skills through well-designed activities and community integration. Other areas of focus include skills to promote independence through daily living skills, social interactions, cooking, health & fitness, and leisure activities. OASIS promotes social interaction with peers and within the community.
New participants may be placed on a waitlist until a spot becomes available. Note, residents will receive priority on a waitlist before non-residents. To be placed on the waitlist, all prospective participants must have completed initial intake process and registration forms. Individuals must be able to participate successfully at a staff to participant ratio of 1:6-1:4. Prior to acceptance, SWSRA will complete an intake assessment and determine that eligibility requirements are met.
Days: OASIS is offered Monday-Friday; participants can register for 2-5 days a week.
Dates: September 8, 2026 - May 28, 2027; The program follows the days off and holidays of a local school district calendar.
Time: 10:00am - 2:00pm
Location: Worth Park District - Terrace Centre, Worth
Monthly Fee: 2 Day Option: $430 (R), $645 (NR)
3 Day Option: $595 (R), $890 (NR)
4 Day Option: $750 (R), $1,125 (NR)
5 Day Option: $935 (R), $1,405 (NR)
Sensory Depot
A sensory room is a specifically designed environment for people ages 3 to adult with various ability levels to experience a variety of senses and to assist in developing specific skills. Sensory rooms are used to create a safe atmosphere to relax and benefit specific sensory processing difficulties.
By Appointment Only Monday - Saturday.
Benefits May Include:
• Improved mood
• Improved communication
• Decreased anxiety
• Decreased fear
• Enhanced interpersonal interactions
• Fewer disruptive behaviors Who May Benefit:
• Autism Spectrum Disorders
• ADHD
• Sensory processing disorders
• Dementia
Sensory Depot Offers:
• Aromatherapy
• Relaxing sounds and lights
• Interactive tools to promote skills and tranquility
• Bubble tubes
• Fiber optic lights
• And much more!
Sensory Depot Location:
• 10707 S. Oak Park Ave., Worth, IL
• Individual Sessions:
• ONE Session is 30 Minutes
• 1 Session for $10
• 5 Sessions for $45
• 10 Sessions for $90
Group Trips:
Ask to speak with a Recreation Team Member for group rates at 708-389-9423.
How to Register:
• Call or visit SWSRA's main office at:
– 708-389-9423
– 12521 S. Kostner Ave., Alsip
Cancellations made 4 hours or less or no-shows will be charged a fee of $15 and the cost of the session.
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:30pm-7:00pm Painters Club
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:00pm-6:00pm Board & Bags
JUNE 2026
5:00pm-6:00pm Board & Bags
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:30pm-7:00pm Painters Club
5:00pm-6:00pm Board & Bags
11:30am-12:00pm Lunch w/Friends 4:00pm-4:30pm Games Galore 5:00pm-6:00pm Bowling
11:30am-12:00pm Lunch w/Friends 4:00pm-4:30pm Games Galore 5:00pm-6:00pm Bowling
11:30am-12:00pm Lunch w/Friends 4:00pm-4:30pm Games Galore 5:00pm-6:00pm Bowling 6:30pm-8:30pm Socialites
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 6:00pm-7:00pm Pickleball 6:30pm-8:30pm Socialites
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 6:00pm-7:00pm Pickleball
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 7:00pm-9:00pm Friday Night Lights
10:00am-11:30am Step It Out 4:30pm-10:00pm Windy City Thunderbolts Game 1:00pm-2:30pm Sensory Summer 3:30pm-5:30pm Ice Cream Cake Creation 30 1 2
10:00am-11:00am Bakers Club 2:00pm-3:30pm Vanilla Milkshakes & Games
12:15pm-4:15pm Centennial Park Aquatic Center
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:30pm-7:00pm Painters Club
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:00pm-6:00pm Board & Bags
JULY 2026
5:00pm-6:00pm Board & Bags
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:30pm-7:00pm Painters Club
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO
5:00pm-6:00pm Board & Bags
11:30am-12:00pm Lunch w/Friends
4:00pm-4:30pm Games Galore
5:00pm-6:00pm Bowling
11:30am-12:00pm Lunch w/Friends
4:00pm-4:30pm Games Galore
5:00pm-6:00pm Bowling
11:30am-12:00pm Lunch w/Friends
4:00pm-4:30pm Games Galore
5:00pm-6:00pm Bowling
11:30am-12:00pm Lunch w/Friends
4:00pm-4:30pm Games Galore
5:00pm-6:00pm Board & Bags
5:00pm-6:00pm Bowling
4:30pm-5:15pm; 5:15pm-6:00pm Basketball Skills & Drills
6:30pm-8:30pm Socialites
4:30pm-5:15pm; 5:15pm-6:00pm Basketball Skills & Drills
4:30pm-5:15pm; 5:15pm-6:00pm Basketball Skills & Drills 6:30pm-8:30pm Socialites
9:00am-9:30am Coffee Talk
4:00pm-4:30pm BINGO 6:00pm-7:00pm Pickleball
4:30pm-5:15pm; 5:15pm-6:00pm Basketball Skills & Drills
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 6:00pm-7:00pm Pickleball
6:00pm-8:00pm Pizza & Movie Night
6:00pm-8:30pm NWCSRA Hawaiian Luau Dance 31
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 6:00pm-7:00pm Pickleball 6:00pm-7:00pm Pickleball
10:00am-11:00am Bakers Club 5:30pm-7:30pm Loaded Fries
1:00pm-3:00pm Stone Owls 10:00am-11:00pm Science Quest 1:00pm-2:30pm Bada-BINGO
AUGUST 2026
9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 9:00am-9:30am Coffee Talk 4:00pm-4:30pm BINGO 5:00pm-7:00pm Movie Magic 6:00pm-7:00pm Pickleball
10:00am-11:00am Bakers Club 1:00pm-2:30pm Experiment Zone 5:30pm-7:30pm Cheddar, Bacon & Chicken Melt TBD Afternoon Movie 11:30am-12:00pm Lunch w/Friends 4:00pm-4:30pm Games Galore 5:00pm-6:00pm Bowling
6:45pm-10:30pm SSSRA Movie Under the Stars
Program Policies
BEHAVIOR GUIDELINES
SWSRA promotes the concept of “equal fun for everyone.” Participants, Family Members, and Guardians are expected to exhibit appropriate behavior at all times. SWSRA’s behavior guidelines have been developed to help make the programs safe and enjoyable for all participants.
1. Participants, Family Members, and Guardians must show respect to all participants, staff, and volunteers.
2. Participants, Family Members, and Guardians must refrain from threatening or causing bodily harm to self, other participants, or staff.
3. Participants, Family Members, and Guardians must refrain from using foul language or discussing inappropriate topics.
4. Participants, Family Members, and Guardians must show respect for equipment, supplies, and facilities.
5. Additional rules may be developed for specific programs and athletic programs as deemed necessary by staff.
6. If inappropriate behavior occurs, a prompt resolution will be sought specifically to each individual’s situation. SWSRA reserves the right to dismiss participants whose behavior endangers the safety of themselves or others. Actions may be, but not limited to: Participants, Family Members, and/ or Guardians sent home, suspend the Participants, Family Members, and/or Guardians, or expel the Participants, Family Members, and/or Guardians.
DROP OFF/PICK-UP & DROP OFF POLICY
SWSRA asks that participants arrive no earlier than 5 minutes prior to the start of a program or slated pickup time, and be picked up promptly at the end of the program or slated drop-off time. SWSRA requires you to walk the participant(s) into and out of the building and/or their program room. Please do not drop off or leave anyone early or without a staff member present.
LATE PICK-UP FEE POLICY
Please pick-up participants at the designated times. If parents/guardians are not on time for a participant pick-up/drop-off, a $15 fee will be assessed after 15 minutes late and every 15 minutes thereafter. This fee assists us in paying for the additional staff wages. In addition, for anyone 5 minutes late, in excess of 2 times, the fee will start at 5 minutes late, from there on after.
SEVERE WEATHER CANCELLATIONS
In the event of severe weather, SWSRA may cancel programs in the best interest of our participants. For the safety of our participants, program supervisors may make the decision to cancel a program in progress, should weather become questionable. The following guidelines will be used to determine cancellations:
Severe Cold Weather
• Outdoor programs: Temperature range of 0 degrees or less, including wind chill.
• Programs with transportation: Temperature of 0 degrees or less, including wind chill.
• All programs (including indoor): Snowstorm situations when driving restrictions (winter storm or blizzard warning in which authorities have advised not going out unless necessary) and emergency accident plans (state and local police) are in effect.
Severe
Hot Weather
• Outdoor programs, or indoor sites without airconditioning, a heat index of 100 degrees or higher.
• Programs with Transportation: Heat index of 100 degrees or higher.
• All programs (including indoor): Weather situations when a tornado warning is in effect.
High Wind Advisory
• When there is a high wind advisory in effect, strong winds can make driving difficult, especially for high profile vehicles.
PROGRAM CANCELLATIONS
SWSRA attempts to hold programs whenever possible. However, inclement weather or emergencies occasionally make it difficult for participants and staff to travel to program locations. SWSRA’s cancellation guidelines are as follows:
• At the scheduled program time, if no participants arrive within the first 30 minutes, the program session will be canceled, and staff will be sent home. NO refunds will be given.
• SWSRA staff look at all circumstances, (weather reports), two hours prior to the starting time of the program or transportation route to determine if the program should be canceled.
• If the program is canceled, staff will attempt to reach all participants by phone to inform them. You will only be called if the program is canceled.
• If SWSRA cancels a program, we will make attempts to extend the program to make up missed dates.
• SWSRA will make calls announcing any program extensions.
Program Policies
PROGRAM GUIDELINES
1. SWSRA reserves the right to determine and or decline participant appropriateness for programs, trips, special events and overnight trips based on the participant appropriateness for the activity(s).
2. When arriving and departing a program, parents/ guardians/group home staff are required to notify the Program Leader.
3. If a participant cannot attend a program, he/she cannot send a substitute in their place.
4. When participants of varying ages and ability levels are in the same program, SWSRA will group them appropriately.
5. SWSRA provides appropriate staff-to-participant ratios based on the information provided to us on the registration form, annual master, and parent/ teacher input & new participant assessments. We provide an approximate 1:4 staff-to-participant ratio.
6. SWSRA is not responsible for lost or stolen property. Participants are encouraged to leave valuables at home.
7. With the participant’s best interest in mind, we have found that having parents/guardians, and/ or siblings present during a program can tend to distract participants during program time. This can affect the quality of their participation. Our staff always welcome the opportunity to discuss a participant’s progress with parents/guardian at any time.
8. Vacation Trips, Weekend Trips, and Overnights: Participants must be completely independent in their daily life skills. SWSRA does not provide supervision of participants after “lights out” and during sleeping hours. Participants must be able to function in a 1:4 staff-to-participant ratio, and have participated in SWSRA weekly programs at least one season before registering for any of these types of trip(s).
GUIDELINES WHEN ILLNESS OCCURS
• To prevent the spread of contagious illnesses, it is recommended that participants refrain from attending programs when any of the following conditions exist:
– Fever of 100 degrees or higher.
– Vomiting within the last 24 hours.
– Persistent diarrhea in conjunction with other symptoms.
– Contagious rash or a rash of unknown origin or ringworm.
– Persistent cough and/or cold symptoms.
– “Pink eye” (conjunctivitis) or discharge from the eye.
– Symptoms of mumps, measles, chicken pox, strep throat, flu, impetigo, coxsackie virus
– Head lice or mites
– Runny nose with yellow or green discharge, which indicates infection.
• Please notify the SWSRA office of any contagious disease that will affect attendance. Participants can return at doctor’s recommendation, or when symptoms have clearly passed.
COVID-19 GUIDELINES
SWSRA will continue to follow the Governors Executive Orders as well as CCDPH, the IDPH, CDC and our risk management agency guidance as we have done throughout the pandemic. Information is subject to change at anytime.
• Masks are not required but RECOMMENDED for all SWSRA participants and staff.
• Participants must provide their own mask.
• We ask that participants bring a mask, should one be needed for an emergency.
• Participants displaying COVID-19 related symptoms during a program will be removed from the group. Staff will immediately call guardian/family and be required to pick up participant within 15 minutes of notification.
• In the event program has a known outbreak of COVID-19 the following will be done:
– Program will shut down in-person programming for a minimum of 5 days.
In the event a participant has COVID-19 or is exposed to a known or suspected case of COVID-19, the following guidelines in accordance with the CDC and IDPH are to be followed:
• If a participant tests POSITIVE for COVID-19, regardless of vaccination status, participant must stay home for 5 days. If participant is displaying no symptoms or symptoms have resolved as well as fever free for 24 hours, participant may return but must wear a mask for 5 additional days.
• If a participant has been exposed to someone with COVID-19, they will be required to wear a mask for 10 days.
SWSRA staff has the right to deny participation to any individual exhibiting symptoms of a contagious illness.
For additional policies and guidelines, visit our website at www.swsra.org
Supporters & Sponsors
Kim Killela
Mott Family
Murphy Family
Timothy and Rosemary Pilny-Meadowlark Haunt
Joan Strainis
SWSRA WAIVER, RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT
(Signature required annually with MASTER FORM and notify SWSRA if any information changes)
SWSRA is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. SWSRA continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants' safety. However, participants and parents/guardians of minors registering for the programs/activities listed above must recognize that there is an inherent risk of injury when choosing to participate in recreational programs/activities. You are so lely responsible for determining if you or your minor/child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way, or recently suffered an illness, injury, or impairment, to consult a physician before undertaking any physical activity. Recreational programs/activities are intended to challenge and engage the physical, mental, and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational program/activity. Understandably, not all hazards and dangers can be foreseen. Depending on the particular activity, participants must understand that certain risks, dangers, and injuries due to i nclement weather, slipping, falling, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, premises, defects, inadequate or defective equipment, animal bites, inadequate supervision, instruction or officiating and all other circumstance inherent to indoor and outdoor recreational activities/programs exist. In this regard, it must be recognized that it is impossible for SWSRA to guarantee absolute safety. Please read this form carefully and be aware that in signing up and participating in the above-identified programs/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages, or loss which you or your minor/child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided).
Virtual Programs and Online Activities: You should consult your physician or other health care professional before starting this or any other fitness program/activity to determine if it is right for your needs. If you experience faintness, dizziness, pain, or shortness of breath at any time while exercising you should stop immediately. If you choose to exercise to this virtual program/activity, you do so at your own risk and acknowledge that the exercises carry an inherent risk of physical injuries. To the extent permitted by law, SWSRA and its affiliates disclaim any and all liability in connection with the exercises in the video and any instructions and advice provided. I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages, or loss, regardless of severity, that my minor/child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims, I or my minor/child/ward may have (or accrue to my minor/child/ward or myself), as a result of participating in these programs/activities against SWSRA including its officials, agents, volunteers and employees (hereinafter collectively referred as SWSRA). I do hereby fully release and forever discharge SWSRA from any and all claims of injuries, damage, or loss that my minor/child/ward or I may have or which may accrue to myself or my minor/child/ward and arising out of, connected with, or in any way associated with these programs/activities. I have read and understand the above important information, warning of risk, assumpt ion of risk and waiver and release of all claims. If registering online or via fax, your online or facsimile signature shall substitute for and have the same legal effect as an original form signature.
Say Cheese!
SWSRA occasionally takes photographs or videos of participants for promoting/advertising our programs, services, events, activi ties, and facilities in our brochures, website or agency social media, and other promotional avenues. By registering for, participating in, or attending SWSRA programs, events, or other activities, the participant (or parent/guardian of a minor/child/ward participant) irrevocably agrees to the use and distribution by SWSRA of his or her image (or of his minor/child/ward) in photographs, video recordings, and any other electronic reproductions of such programs, events, and activities for any purpose without inspection or approval and without compensation, rights to royalties, or any other consideration now and in the future.
Print Participant’s Name:_______________________________________________________Date:_______________________
Signature:
(If Under 18, Parent/Guardian Signature)
Print Name of Signature:
Participant’s Name (Last) _______________________________________(First) ___________________________________________
Address _________________________________________________ City _______________________________ Zip _______________
Primary Disability
Secondary Disability
Sex: Female ______ Male ______ Age: _____ Birthdate: (MM/DD/YY) _____ /_____ /_____
*E-mail: _______________________________________________________________
GROUP HOME PARTICIPANTS ONLY: Name of Group Home/House _______________________________________________________________
* By providing your e-mail address, you give SWSRA consent to send you promotional materials via e-mail and will only be used b y SWSRA. You can request to be taken off SWSRA’s mailing list at any time.
Case Manager _______________________________________ Work # _____________________________
House Manager _______________________________________ Work # _____________________________
EMERGENCY CONTACT INFORMATION REGARDING PARTICIPANT IN ORDER OF PREFERENCE:
In the event of an emergency, cancellation of program, etc., list in order of preference those who have your consent and authorization to pick up participant if needed.
MEDICAL INFORMATION:
A. Wheelchair: *Yes_____ No_____ *If Yes, completion of SWSRA FORM 1 required
B. Seizures: *Yes_____ No_____ *If Yes, completion of SWSRA FORM C (pages 1-3) required Is Vagus Nerve Stimulation (VNS) Used: Yes _____ No_____ *Note: In case of a seizure, you will be notified
C. Asthma: *Yes_____ No_____ *If Yes, completion of SWSRA FORM A (pages 1-2) required
D. G-Tube: *Yes_____ No_____ *If Yes, completion of SWSRA FORM B (pages 1-5) required
E. List any other Medical Conditions AND/OR Assisted Devices *Note: Additional forms may be required
F. Allergies: *Yes No *If Yes, Please Complete Chart Below
ALLERGIES
MEDICATION
INSECT BITES/STINGS
OTHER
MEDICAL INFORMATION CONTINUED:
C. Will staff need to assist with Medication during program? *Yes ____ No ____ *If Yes, SWSRA FORM 4 (pages 1-2) will be required to complete
A. Doctor's Name: ________ ____Phone: ___ _______________
B. Medication: SWSRA needs to know ALL medications participant is taking, regardless of when/where dispensed. Please list ALL medications below: (If more than 4 medications, please attach a separate sheet)
TYPE OF MEDICATION
C. Medication Assistance: Will staff need to assist with Medication during program? *Yes _____ No _____ *If Yes, SWSRA FORM 4 (pages 1-2) will be required to complete
COMMUNICATION & ADDITIONAL INFORMATION:
A. T-Shirt Size: CHILD SIZES: S(6-8) _____ M(10-12) _____ L(14-16) _____ ADULT SIZES: S_____ M_____ L_____
B. General Questions:
Please fill out the following questions thoroughly so that we can best serve your participant.
1. Participant’s favorite activities are: __________________________________________________________________________________
2. Participant should not eat (please consider allergies/medical conditions) _______________________________________________
3. Inappropriate behaviors participant displays: ___________________________________________________________________________ ______
4. Areas/Goals for the participant to work toward: _________________________________________________________________________ ______
5. Toilet Training: ____________________________________________________5b. Does Participant require assistance? Yes ______ No ______
6. SWSRA provides an approximate 1:4 staff-to-participant ratio. Please note if you are requesting a closer ratio and why:
C. Sensory Needs:
1. Please list what sensory equipment is needed or used: ____________________________________________________________________
D. Visual Supports and Communication: Verbal ______ Nonverbal ______ ______Communication Device, please list: __________________________________ _______ Picture Exchange Communication System(PECS) ______Visual Directions _______ ASL American Sign Language _______ Homemade Sign ______Cue Cards (stop, wait, sit, etc.) _______ Other Languages: ___________________________ ______ Read Lips
E. Swim Information:
1. Pre-beginner _____ Beginner _____ Intermediate _____ Advanced _____
2. Does participant use: Flotation device? Yes ______ No ______ Ear plugs? Yes _______ No______
3. Is participant allowed to swim in deep water? Yes ______ No ______
PERMISSIONS:
1. Parents/Guardians are asked to provide bug spray & sunscreen. Can staff apply these products on participant? Yes _______ No ______
2. Transportation Permission: Transportation as a part of weekly activities, special events, or trips? Yes ______ No ______
Signature (If under 18, parent/guardian signature please) Date
*Note: This SWSRA MASTER FORM is completed annually. Please notify SWSRA if any information changes.
