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SPRING 2024 • SEASONAL PROGRAM BROCHURE

Building Community through Recreation

REGISTRATION DATES RESIDENT ONLY - PRIORITY • FEBRUARY 19 - FEBRUARY 23 RESIDENT/NON-RESIDENT/CO-OP • FEBRUARY 26 - MARCH 1 SPRING 2024

VISIT US AT WWW.SWSRA.ORG OR CALL 708-389-9423

Welcome A Letter from the Executive Director Dear SWSRA Family & Friends, Spring Season is here! So many exciting new things have been happening at SWSRA. If you have not heard the exciting news, we are all moved into our new office space at the Apollo Recreation Center. Please also join us in officially

Who We Are

Registration

Agreements

Virtual Programs

Programs

7–8

you as you walk into the Apollo Recreation

Special Events

9–11

Center at the Front Registration Desk to assist

Recreation Boxes

OASIS Adult Day Program

Sensory Depot

welcoming Jessica Jurlow. Jessica can welcome

with all registration needs. We also want to congratulate Patti Swiney on her role as Business Manager. Dawn Kehoe has retired from her role as Business Manager at SWSRA after 10 years. She will be greatly missed by all but we are excited for Dawn as she embarks on this new chapter enjoying time with her husband, children and grandchildren. Spring registrations March 18th please be sure to mark your calendars and take a

Calendar

15–17

Program Policies

18-19

Supporters & Sponsors

season. Below is just a brief highlight of some of the fun coming your way:

Program Registration Form

Youth

SWSRA Waiver & Release

look at all of the wonderful opportunities our recreation team is bringing to you this

• Silly Scientist Program • FREE EVENT-Sensory Depot Open House- *registration required Teens • NEW-Teen Club-4 week program (teen only program) Teens & Adults • NEW-Hanging with my Gnomies-Event • NEW-French Toast and Scrambled Eggs-Event • Special Olympics Softball-Program • Family Paint Night-Family Event • Spring Formal Dance-Event* space is limited dont's miss out on registration Don’t miss out on getting your Spring Raffle Ticket! For more information on how to purchase and win please take a look in the brochure. While 2023 was an amazing year we cannot wait to see what 2024 has in store for us. Join us for another year of fun and making memories with all of your friends! Best wishes,

Nicolette D. Lahman-Morales Executive Director

TABLE OF CONTENTS

SPRING 2024

SWSRA Master Form

23–24

Spring Raffle

SWSRA will not be liable for typographical errors, incorrect insertions, or omissions contained in this brochure publication. In addition, information is subject to change without notice. Spring 2024, Seasonal Program Brochure

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

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 Superintendent of Recreation muher@swsra.com 708-389-9423 ext. 208

Ami Ill Recreation Specialist aill@swsra.com 708-389-9423 ext. 210 Brittany Izzo, CTRS Recreation Supervisor bizzo@swsra.com 708-389-9423 ext. 207 Tina Izzo-Delbovo Recreation Supervisor tizzo-delbovo@swsra.com 708-389-9423 ext. 212 Jessica Jurlow Main Office Clerk jjurlow@swsra.com 708-389-9423 ext. 201

BOARD OF DIRECTORS Alsip Park District Jeannette Huber

Midlothian Park District Ed Jung

Blue Island Park District Ted Ruthenberg

Palos Heights Parks & Recreation Department Matt Fairbanks Posen Park District T.J. Whitcomb Worth Park District Robert O’Shaughnessy

Hickory Hills Park District Jennifer Fullerton

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.

Merrionette Park Michelle Higgins

VISION STATEMENT

SWSRA Main Office 12521 South Kostner Avenue, Alsip, IL 60803 Phone: 708-389-9423 Fax: 708-389-6458 Website: www.swsra.org

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.

SPRING 2024

Registration PROGRAM DATES March 18 - May 11

REGISTRATION DATES

Residents Only - Priority Registration* February 19 - February 23 Resident/Non-Resident/Co-Op Registration February 26 - March 1

*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.

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

Any registration that is received prior to your specific registration week will be processed on the second business day of your designated registration week.

SWSRA PROGRAM LOCATION(S)

HOW TO REGISTER

Alsip Park District - Apollo 12521 S. Kostner Avenue Alsip, IL 60803

Memorial Park 145th & Sawyer Midlothian, IL 60445

Burr Oak Bowl 3030 W. 127th Street Blue Island, IL 60406

Palos Heights Parks & Recreation Center 6601 W. 127th Street Palos Heights, IL 60463

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

SPRING 2024

Culver's 20592 South LaGrange Road Peaks Park 6701 W 107th Steet Frankfort, IL 60423 Worth, IL 60482 Emagine Theater 20592 South LaGrange Road Worth Community Center 10707 S. Oak Park Avenue Frankfort, IL 60423 Worth, IL 60482 In the Game Hollywood Worth Park District Park Terrace Center 5051 Cal Sag Road 11500 S. Beloit Avenue Crestwood, IL 60418 Worth, IL 60482 Lincolnway Special Recreation Center 1900 Heatherglen Drive New Lenox, IL 60451

Agreements Information & Cooperative

LINCOLNWAY SPECIAL RECREATION ASSOCIATION COOPERATIVE AGREEMENT

MASTER REGISTRATION FORM

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.

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.

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. SPRING 2024

Virtual Programs VIRTUAL RECREATION PROGRAMS

Virtual Recreation Programs Description

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.

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.

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: March 18-May 10 No Program March 29 Fee: $45: 8 Week Access

VIRTUAL CLUB DAY

TIME

Coffee Talk

Monday

9:00am-9:30am

BINGO

Monday

3:00pm-3:30pm

Lunch with Friends Wednesday 11:30am-12:00pm Movies & More

Wednesday 3:00pm-3:30pm

Coffee Talk

Friday

9:00am-9:30am

BINGO

Friday

3:00pm-3:30pm

SPRING 2024

Movies & More: Let’s watch trailers to the newest upcoming movies and discuss if it’s going to thrill you! We will also have movie trivia. Lunch with Friends: Bring your lunch and socialize with your friends. We will discuss current events, video games, movies and much more!

Weekly Schedule PROGRAM

Coffee Talk: Grab your favorite morning beverage (water, tea, coffee, juice,etc.) and begin your morning talking with your peers.

Baker's 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! You will receive an email with the link and supply list the Friday prior to the season starting. Group: Teens & Adults Day: Saturday Dates: March 23, April 6, April 20, April 27 Time: 10:00am-11:00am Fee: $50 (R), $63 (NR)

Programs 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. 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: Monday Dates: March 18 - May 6 Time: 5:00pm-6:00pm Location: Burr Oak Bowl, Blue Island

SOFTBALL SKILLS AND DRILLS Ready to get back into the swing of things? Before the upcoming season starts please join us for batting, pitching, throwing, catching and other skills and drills. Be a champion while learning the fundamentals and basics. Fee includes: equipment and staff supervision. Group: Teens & Adults Day: Tuesday Dates: April 16-May 7 Time: 6:30pm-7:30pm Location: Peaks Park, Worth Min/Max: 4/8 Fee: $48 (R), $96 (NR)

Youth Bumper Bowl Min/Max: 3/6 Fee: $118 (R), $236 (NR)

Bowling I Min/Max: 4/8 Fee: $118 (R), $236 (NR)

Bowling II* Min/Max: 4/8 Fee: $150 (R), $300 (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 SOFTBALL SWSRA is calling all softball players to join in America’s pastime. Players will be practicing and competing against other agencies weekly as well as in tournaments. You will hit a home run with this program, so grab your bat and ball and join the team! All players must have a SWSRA Coyotes uniform, see Uniform Fee on the next page. Addtional fees will be required if team qualities for State Competition.

swsra

Fee includes: equipment, TR tournament and staff supervision. Group: Teens & Adults Day: Tuesday Dates: May 14-August 6 No Program July 2 Region E Tournament Date: August 4 Time: 6:30pm-8:00pm Location: Peaks Park, Worth Min/Max: 12/15 Fee: $149 (R), $298 (NR)

SPRING 2024

Programs SOFTBALL UNIFORM FEE

WALKING CLUB

A $50 uniform deposit, which is fully refundable, providing you turn in your uniform clean, on-time and in similar condition it was received. If the uniform is not returned on-time and in good, clean condition, the $50 charge will then become non-refundable. Thank you for your cooperation! Fee: $50 (R), $50 (NR)

These gym shoes were made for walking and that’s just what we're going to do! So, lets get active and walk with our friends around the track! So come and join our Walking Club!

SPECIAL OLYMPICS COYOTES SOFTBALL INDIVIDUAL SKILLS Dust off your glove and spikes! We will be working on throwing, catching, and hitting skills during this 8-week program. Athletes must bring their own softball glove, water bottle, dress in athletic clothing and shoes. Addtional fees will be required if inidividual qualities for State Competition Fee includes: equipment and staff supervision. Group: Teens & Adults Day: Tuesday Dates: June 11-August 6 No Program July 2 Region E Tournament Date: July 28 Time: 6:30pm-7:30pm Location: Memorial Park, Midlothian Min/Max: 4/8 Fee: $124 (R), $248 (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 detract from another participant's experience. Fee includes: supplies, transportation and staff supervision. Group: Adults Day: Thursday Dates: March 21, April 4, April 18, May 2 Time: 6:30pm-8:30pm Location: Meet at Alsip Park District-Apollo, Alsip Min/Max: 4/8 Fee: $145 (R), $290 (NR) Pick Up: Alsip Park District-Apollo 8:45pm 8

SPRING 2024

Fee includes: equipment and staff supervision. Group: Teens & Adults Day: Thursday Dates: March 28, April 11, April 25, May 9 Time: 6:00pm-7:00pm Location: Palos Heights Recreation Center Track, Palos Heights Min/Max: 4/8 Fee: $53 (R), $106 (NR)

SILLY SCIENTISTS Time to break out the lab coats and conduct an experiment. This is a hands-on interactive program inspiring young "scientists" to play, create, explore and learn while they are having fun! Fee includes: supplies and staff supervision. Group: EC & Youth Day: Saturday Dates: April 6-April 27 Time: 10:00am-11:00am Location: Worth Community Center, Worth Min/Max: 3/6 Fee: $47 (R), $71 (NR)

TEEN CLUB Calling all teens! It’s time to play some games, hang out with our friends and make everlasting memories. Fee includes: supplies and staff supervision. Group: Teens Day: Saturday Dates: April 6-April 27 Time: 3:30pm-5:00pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $86 (R), $108 (NR)

Special Events LEMONADE AND GAMES

HANGIN' WITH MY GNOMIES

The birds are starting to come out and the weather is getting warmer. Let’s make a refreshing snack with homemade lemonade. We will play a variety of games with our friends!

Spring is in full swing and that means the garden gnomies are ready to come out for the season. We will paint a garden gnome for your yard and make a mosaic concrete mushroom too! Once we are all done we will have a berry good snack. Concrete mushrooms will be ready for pick up at our main office on Friday, April 12.

Fee includes: snack, supplies, and staff supervision. Group: Teens Day: Friday Date: March 22 Time: 7:00pm-8:30pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $32 (R), $40 (NR) Registration Deadline: March 8

EGGS-ERCISE HUNT Hop on over and join us as we get our “eggs-ercise” on. There is no better way to start your Saturday than joining us for an egg hunt activity. After the egg hunt, we will have a great time creating crafts and a snack. Fee includes: snack, supplies, and staff supervision. Group: EC & Youth Day: Saturday Date: March 23 Time: 11:00am-12:00pm Location: Worth Community Center, Worth Min/Max: 3/6 Fee: $20 (R), $25 (NR) Registration Deadline: March 8

COLOR ME EGG-CITED Egg-stra, Egg-stra! Come and join us to design your own wooden eggs and decorate a garden stone that you can leave outside all year round! After we decorate our egg-citing crafts we will finish off with an egg-celent snack!

Fee includes: snack, supplies, and staff supervision. Group: Teens & Adults Day: Saturday Date: April 6 Time: 1:00pm-3:00pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $42 (R), $53 (NR) Registration Deadline: March 22

SENSORY DEPOT OPEN HOUSE Come on by and explore our sensory room. While you wait for your turn, you will be able to visit different stations. These stations will vary from sensory play, craft and other fun activities. Parents/Guardians must stay for the duration of the event. Group: EC & Youth Day: Sunday Date: April 7 Time: 10:00am-11:00am Location: Worth Community Center, Worth Min/Max: 3/6 Fee: FREE (R), FREE (NR) Registration Deadline: March 22

Fee includes: snack, supplies, and staff supervision. Group: Teens & Adults Day: Saturday Date: March 23 Time: 2:30pm-4:00pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $37 (R), $46 (NR) Registration Deadline: March 8 SPRING 2024

Special Events LWSRA FIESTA

FAMILY PAINT NIGHT

It’s time to get your best fiesta attire and join our SRA friends for a fiesta! We will have a taco dinner and some great music to dance to for the night. Fee includes: admission, dinner, dessert, transportation* and staff supervision.

Enjoy a night out and learn to paint a masterpiece step by step with your loved ones! This event is designed for a parent, or guardian to join their participant to paint a new painting on canvas you will get to take home! A light refreshment will be served at the end of the event. Limited Spots Available

Group: Teens & Adults Day: Friday Date: April 12 Time: 6:30pm-9:00pm Location: Lincolnway Special Recreation Center, New Lenox Min/Max: 4/8 Fee with Transportation: $77 (R), $154 (NR) Fee without Transportation: $65 (R), $130 (NR) *Meet at Lincolnway Special Recreation Center Registration Deadline: March 22

Fee includes: instruction, snacks and supplies. Group: Teens & Adults Day: Friday Date: April 19 Time: 6:30pm-8:30pm Location: Worth Community Center, Worth Min/Max: 4/12 Fee for Guardian & Participant: $70 (R), $88 (NR) 1 Additional Family Member: $25 (R), $31 (NR) Registration Deadline: April 5

WITH TRANSPORTATION Meet at Alsip Park District-Apollo: 5:45pm Pick up at Alsip Park District-Apollo: 9:45pm WITHOUT TRANSPORTATION Meet at Lincolnway Special Recreation Center: 6:30pm Pick up at Lincolnway Special Recreation Center: 9:00pm

FRENCH TOAST & SCRAMBLED EGGS Who doesn’t love breakfast for dinner? Get ready to get into the kitchen to make homemade french toast, scrambled eggs, sausage and bacon for dinner. Fee includes: supplies, and staff supervision. Group: Teens & Adults Day: Saturday Date: April 13 Time: 6:00pm-7:30pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $37 (R), $46 (NR) Registration Deadline: March 28

SPRING 2024

BINGO BLAST It’s time to play some B-I-N-G-O! We will start off making and enjoying a snack, then we will play several rounds of BINGO! Everyone will receive a prize for joining us! Fee includes: snack, supplies, and staff supervision. Group: Teens & Adults Day: Saturday Date: April 27 Time: 1:00pm-2:30pm Location: Worth Community Center, Worth Min/Max: 4/8 Fee: $33 (R), $41 (NR) Registration Deadline: April 12

Special Events PICTURE PERFECT

SPRING FORMAL

Rise and shine! What better way to welcome spring than a morning craft. Join us in making mosaic tile picture frames. This picture frame will be one of a kind and perfect for your favorite photo.

You are cordially invited to this year’s SWSRA Spring Formal. Gather your glamorous gowns and suits for an unforgettable night of dancing and fun.

Fee includes: supplies and staff supervision. Group: EC & Youth Day: Sunday Date: April 28 Time: 10:00am-11:00am Location: Worth Community Center, Worth Min/Max: 3/6 Fee: $19 (R), $24 (NR) Registration Deadline: April 12

Fee includes: dinner, dessert, DJ, and staff supervision. Group: Teens & Adults Day: Friday Date: May 10 Time: 6:30pm-9:00pm Location: Alsip Park District-Apollo, Alsip Min/Max: 4/8 Fee: $35 (R), $70 (NR) Registration Deadline: April 12

SENSORY SPRING Let's welcome spring with some sensory activities and sensory room time. During our time we will explore different sensory bags and create one to take home. Fee includes: Sensory Depot, supplies, and staff supervision. Group: EC & Youth Day: Friday Date: May 3 Time: 5:30pm-6:30pm Location: Worth Community Center, Worth Min/Max: 3/6 Fee: $17 (R), $21 (NR) Registration Deadline: April 19

IN THE GAME HOLLYWOOD PARK Game on! Let’s enjoy a hot pizza lunch, a round of mini golf and play some games! Participants will receive a game card with credits. Participants can bring additional funds to add to their game cards. Fee includes: lunch, game card, mini golf and staff supervision. Group: Teens & Adults Day: Saturday Date: May 4 Time: 12:00pm-2:45pm Location: Meet at In the Game Hollywood Park, Crestwood Min/Max: 4/8 Fee: $68 (R), $136 (NR) Registration Deadline: April 5

MOVIE AND LUNCH Let's start our day with a morning matinee at the theater and then enjoy a delicious lunch after! We are headed to Emagine Frankfort to see a movie. After we enjoy our time at the cinema, we are headed to Culvers for lunch. Participants will receive a value basket of their choice with fries and a medium soft drink. Participants can bring money for snacks during the movie or for additional food. Fee includes: movie ticket, lunch, transportation and staff supervision. Group: Teens & Adults Day: Saturday Date: May 11 Time: Families will be called one week prior for the time of the event. Location: Meet at Alsip Park District-Apollo, Alsip Min/Max: 4/8 Fee: $103 (R), $206 (NR) Registration Deadline: April 26

SPRING 2024

Recreation Boxes SUNCATCHER EGGS

SPRING IS IN THE AIR

Let’s take a twist on egg decorating and decorate unique suncatcher eggs for our windows! Supplies include: black glue, a variety of egg designs, sharpies, 4-transparency film sheets and glue dots.

Up, up and away! Spring is in the air and to bring on the new season let’s make a wonderful button hot air balloon canvas! Supplies include: assorted buttons, one canvas, paint, glue, ribbon and twine.

Group: All

Fee: $25

Delivery (Residents ONLY): $5

Registration Deadline: March 1

Registration Deadline: March 15

Pick up & Delivery Date: March 8

Pick up & Delivery Date: March 22

Pick up Location: Main Office (Alsip Park District-Apollo)

Delivery: Date listed above, time will be between 10:00am-11:00am

Participants creating past program crafts below.

SPRING 2024

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/ATP/Co-Op. 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: 2-Day: Tuesday & Thursday | 3-Day: Tuesday, Thursday & Monday/Friday | 4-Day: Monday, Tuesday, Thursday & Friday Dates: September 5, 2023 - May 24, 2024; 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: $415 (R), $519 (ATP), $623 (NR) 3 Day Option: $595 (R), $740 (ATP), $890 (NR) 4 Day Option: $750 (R), $920 (ATP), $1,125 (NR)

SPRING 2024

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

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

Who May Benefit: • Autism Spectrum Disorders • ADHD • Sensory processing disorders • Dementia

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

Sensory Depot Offers: • Aromatherapy • Relaxing sounds and lights • Interactive tools to promote skills and tranquility • Bubble tubes • Fiber optic lights • And much more! 14

SPRING 2024

Cancellations made 4 hours or less or no-shows will be charged a fee of $15 and the cost of the session.

Calendar Programs & Events MARCH 2024 SUNDAY

MONDAY

TUESDAY

WEDNESDAY THURSDAY

FRIDAY

SATURDAY

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

25 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

27 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

6:30pm-8:30pm Socialites

22 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 7:00pm-8:30pm Lemonade & Games

10:00am-11:00am Baker's Club 11:00am-12:00pm Eggs-ercise Hunt 2:30pm-4:00pm Color Me Egg-cited

6:00pm-7:00pm Walking Club

COLOR KEY BLUE: Virtual Program DARK GREEN: In-Person Program LIGHT GREEN: Special Event SPRING 2024

Calendar Programs & Events APRIL 2024 SUNDAY

MONDAY

TUESDAY

11:00am-12:00pm Sensory Depot Open House

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

15 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

22 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

10:00am-11:00am Picture Perfect

3 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

WEDNESDAY THURSDAY

10 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

16 6:30pm-7:30pm Softball Skills & Drills

23 6:30pm-7:30pm Softball Skills & Drills

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

6:30pm-7:30pm Softball Skills & Drills

17 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

24 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

FRIDAY

6:30pm-8:30pm Socialites

5 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO

6:00pm-7:00pm Walking Club

13 10:00am-11:00am Silly Scientists 3:30pm-5:00pm Teen Club 6:00pm-7:30pm French Toast and Scrambled Eggs

19 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 6:30pm-8:30pm Family Paint Night

6:00pm-7:00pm Walking Club

10:00am-11:00am Baker's Club 10:00am-11:00am Silly Scientists 1:00pm-3:00pm Hangin' with My Gnomies 3:30pm-5:00pm Teen Club

12 9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 6:30pm-9:00pm LWSRA Fiesta

6:30pm-8:30pm Socialites

SATURDAY

20 10:00am-11:00am Baker's Club 10:00am-11:00am Silly Scientists 3:30pm-5:00pm Teen Club

26 10:00am-11:00am 27

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO

Baker's Club 10:00am11:00am Silly Scientists 1:00pm-2:30pm BINGO Blast 3:30pm-5:00pm Teen Club

COLOR KEY BLUE: Virtual Program DARK GREEN: In-Person Program LIGHT GREEN: Special Event 16

SPRING 2024

Calendar Programs & Events MAY 2024 SUNDAY

MONDAY

TUESDAY

WEDNESDAY THURSDAY

1 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:00pm-6:00pm Bowling

6:30pm-7:30pm Softball Skills & Drills

8 11:30am-12:00pm Lunch w/Friends 3:00pm-3:30pm Movies & More

FRIDAY

6:30pm-8:30pm Socialites

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 5:30pm-6:30pm Sensory Spring

12:00pm-2:45pm In the Game Hollywood Park

6:00pm-7:00pm Walking Club

SATURDAY

9:00am-9:30am Coffee Talk 3:00pm-3:30pm BINGO 6:30pm-9:00pm Spring Formal

Movie & Lunch

6:30pm-8:00pm SO Coyotes Softball

COLOR KEY BLUE: Virtual Program DARK GREEN: In-Person Program LIGHT GREEN: Special Event SPRING 2024

Program Policies BEHAVIOR GUIDELINES

SEVERE WEATHER CANCELLATIONS

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.

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.

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. 18

SPRING 2024

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.

SPRING 2024

Supporters & Sponsors

THANK YOU TO OUR SUPPORTERS Ami Ill Brittany Izzo Dawn & John Kehoe Jeri-Lynn Kleinas Marina Uher Mary's Foundation Mott Family Nicolette Lahman

VISIT WWW.SWSRA.ORG TO HELP SUPPORT US 20

SPRING 2024

Spring 2024 Program Registration Registration Dates: Residents Only: February 19 - February 23 | Non-Resident/Co-Op: February 26 - March 1

Participant Name: ___________________________________________________________________________________________________________ Address______________________________________________________________ City ________________________________ Zip ______________ Phone ________________________________________ Age __________________ Birth Date __________________________________________ Main Contact: Name _______________________________ Phone__________________________ Email _____________________________ Teens & Adults Virtual

Res. Fee $45

Virtual Recreation Programs

Teens & Adults Virtual Club

Res. Fee $50

Baker’s Club

Teens & Adults Programs

Res. Fee

Bowling I Bowling II Softball Skills & Drills Special Olympics Coyotes Softball *Uniform Deposit Special Olympics Coyotes Individual Skills Socialites (A) Teen Club (T) Walking Club

Youth Programs

Res. Fee $25 $25 $5

Suncatcher Eggs Spring is in the Air Delivery

Non-Res. Fee

$290 $108 $106

$20 FREE $19 $17

Recreation Boxes

$63

$145 $86 $53

Res. Fee

Eggs-ercise Hunt Sensory Depot Open House Picture Perfect Sensory Spring

Non-Res. Fee

$236 $300 $96 $298 $50 $248

$118 $47

EC & Youth Events

$45

$118 $150 $48 $149 $50 $124

Res. Fee

Youth Bumper Bowl Silly Scientists

Non-Res. Fee

$40 $46 $53

$77 $65 $37 $70 $25 $33 $68 $35 $103

$154 $130 $46 $88 $31 $41 $136 $70 $206

Spring Raffle

Fee

1 Raffle Ticket 2 Raffle Tickets + 1 Free 5 Raffle Tickets + 3 Free

$10 $20 $50

$25 FREE $24 $21

Non-Res. Fee $25 $25

1 - 30 Minute Session Punch Card - 5 Sessions Punch Card - 10 Sessions

$10 $45 $90

Grand Total:____________________

SWSRA Main Office

Credit Card Type: (Check One) DC

$32 $37 $42

Non-Res. Fee

Fee

Lemonade and Games (T) Color Me Egg-cited Hangin’ with My Gnomies LWSRA Fiesta with Transportation without Transportation French Toast & Scrambled Eggs Family Paint Night 1 additional family member BINGO Blast In the Game Hollywood Park Spring Formal Movie and Lunch

Non-Res. Fee

$236 $71

Sensory Depot - Multi-Sensory Room

Visa

Teens & Adults Special Events Res. Fee

Amex

Amount Charged to Card:________________________________ Print Name on Card:______________________________________

12521 S. Kostner Ave., Alsip IL 60803 Phone: 708-389-9423 Fax: 708-389-6458 www.swsra.org

Card Holder Signature:___________________________________ Account Number:_________________________________________ Verification Code:__________Expiration Date:______________

SPRING 2024

SWSRA SPRING Registration Form - 2024

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 solely 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 inclement 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, assumption 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, activities, 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:____________________________________________________________________________

SPRING 2024

SWSRA Registration Waiver & Release rev 09.10.2020

MASTER FORM (Complete annually and notify SWSRA if any information changes) - Version 3 Participant’s Name (Last) _______________________________________(First) ___________________________________________ Address _________________________________________________ City _______________________________ Zip _______________ Primary Disability _____________________________________________________________________________________________ Secondary Disability ___________________________________________________________________________________________ Sex: Female ______

Male ______

Age: _____ Birthdate: (MM/DD/YY) _____ /_____ /_____

*E-mail: HOME _______________________________________________________________ GROUP 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 by SWSRA. You can request to be taken off

SWSRA’s mailing list at any time. Case Manager _______________________________________ Work # _____________________________ Cell # _________________________

House Manager _______________________________________ Work # _____________________________ Cell # _________________________

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. 1. __________________________________ __________________________ ________________________ NAME (FIRST & LAST) PRIMARY PHONE TO CALL Secondary Phone (if applicable)

__________________________ RELATIONSHIP TO CLIENT

2. __________________________________ __________________________ ________________________ NAME (FIRST & LAST) PRIMARY PHONE TO CALL Secondary Phone (if applicable)

__________________________ RELATIONSHIP TO CLIENT

3. __________________________________ __________________________ ________________________ NAME (FIRST & LAST) PRIMARY PHONE TO CALL Secondary Phone (if applicable)

__________________________ RELATIONSHIP TO CLIENT

4. __________________________________ __________________________ ________________________ NAME (FIRST & LAST) PRIMARY PHONE TO CALL Secondary Phone (if applicable)

__________________________ RELATIONSHIP TO CLIENT

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 FOOD MEDICATION INSECT BITES/STINGS OTHER

DETAILS

TREATMENT(S)

MEDICAL INFORMATION CONTINUED: C. Will staff need to assist with Medication during program?

*Yes ____ No ____

*If Yes, A. Doctor's Name: _____________________________________________________Phone: ________________________________ SWSRA FORM 4 (pages 1-2) will be required to complete 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

DOSAGE/TIME(S)

REACTION/SIDE EFFECT(S)

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_____ XL_____ 2XL____ 3XL____ 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) 24

SPRING 2024

___________________________ Date

*Note: This SWSRA MASTER FORM is completed annually. Please notify SWSRA if any information changes.

I R N P G S RAFFLE

TICKET

$10

WIN THE $250 PRIZE! FRIDAY, MAY 3, 2024 Want a chance to win a $250 cash prize? Enter our Raffle Contest today! Our Raffle Contest is your chance to win big while supporting South West Special Recreation Association. Ticket Prices: $10 Per Ticket Buy 2 tickets and get 1 additional ticket free Buy 5 tickets and get 3 additional tickets free How to purchase? Call or visit our main office to purchase your tickets today! *Prize is based on at least 50 tickets sold. Prize will be prorated if less than 50 tickets are sold.

708-389-9423 | www.swsra.org

SPRING 2024

12521 South Kostner Avenue Alsip, IL 60803 www.swsra.org

VISIT US AT WWW.SWSRA.ORG 26

SPRING 2024