Request for Reasonable Accommodations

Request for Reasonable Accommodation

Program*

Site of Program*

Participant's Name*

Age*

Parent's Name*

Phone*

What reasonable accommodation is required because of participant's disabilities?*

Does participant require one-on-one staff interaction?*

YesNo

What are the participant's physical challenges?*

Is participant self-sufficient for dally needs/personal care?*

What type of behavior issues does participant have?*

Can participant communicate verbally?*

Can participant follow verbal, visual, physical directions?*

Can participant function, with limited assistance, as a member of a large social group?*

Reasonable accommodations will be made based on a review of the request for accommodation. An accommodation is not reasonable if it results in a fundamental change in the program. Each time a participant enrolls in a program, a new request for reasonable accommodation must be made. Failure to make a timely request for a reasonable accommodation may result in delay of the review and implementation of an accommodation or delay the participant's entry into the program. Participants will be unable to attend the program until the request has been reviewed and a determination has been made. Please allow up to five (5) working days for review. I have read (or had read to me) and understand the above information and the minimum requirements for the program on the back of this sheet. Therefore, I believe that with the requested accommodation the participant listed above meets program guidelines.

Participant's Signature*

Date*

Parent/Guardian's Signature (If participant is under the age of 18)

Date*

Physician Comments*

Parents Comments*

Minimum Requirements to Participate in the

"After Hour Kid Power" Program

The "After Hour Kid Power" Program is an organized recreation program for children who would otherwise be in an unsupervised environment. The program is not a preschool, nursery school, nor infant care program. The program is held in elementary school cafeterias with a ratio of one leader to twenty (20) children.

To qualify to participate in the "After Hour Kid" Program, the participant must, with or without a reasonable accommodation:

Be between 5 and 13 years old.
Be able to independently maintain and handle his/her own personal hygiene.
Be able to self-administer his/her own medication.
Be able to follow instructions.
Not pose an imminent threat of physical harm to himself or others.
Be willing and able to comply with the program rules and regulations.
Be able to take responsibility for and handle interactions with other participants and staff.
Be able to move or transfer without the assistance of staff.

The City of Corpus Christi Parks & Recreation Department will allow a participant to provide a personal assistant or caregiver to enter the "After Hour Kid Power" Program site provided the personal caregiver or assistant: 1) is qualified to provide such care, 2) is designated or provided by the parent to administer such care, 3) abides by the rules and regulations of this program and the City, and 4) must provide verifications of a recent criminal history check.

For questions or assistance, call (361) 826-3499.

Thank you for your interest.
You will receive a reply within two business days.
If you have any question, please call (361)-826-3464 or send email.
For the After Hour Kid Power Program, send an email to MickelaH@cctexas.com.
For the Sports Program, send an email to PhillipO@cctexas.com.
For Recreation Centers, send an email to BrittanyD@cctexas.com.
For all others, send an email to JoseR3@cctexas.com.

Corpus Christi Parks & Recreation Department
1201 Leopard Street, Corpus Christi, Texas 78401 | (361)-826-3464