Howard County Accommodation Request
Howard County Department of Recreation & Parks, Therapeutic Recreation Section strives to ensure quality and excellent programs and services to individuals with disabilities. This portal enables us to make appropriate accommodations when requested. Please note the accommodation requests are considered on an individual basis and determined by the needs of the individuals and the program they are participating in. Increasing the staff to participant ratio is not guaranteed and is based on resident status, availability and needs of the individuals. (Those that are not a Howard County resident are welcome to participate in our programs, yet additional staff will not be provided. We will try to train staff the existing staff for out-of-county residents.)

To assist our staff, we are asking parents/caregivers to complete a required intake assessment as well that will be emailed to you once this form is completed. If you do not receive an email response after you have completed this form, please contact someone from our team.

If you have questions or concerns, please contact Susan L Potts, MS, CTRS at 410/313-4628 or spotts@howardcountymd.gov or Tori Taylor, CTRS 410/313-4708 or vtaylor@howardcountymd.gov.

* Please Note: A new request must be made for each program you are registered for. Please fill in the required information for each and every program request. If the information is invalid or incomplete your request maybe be delayed.
Accommodation Request Form
First Name of Person Completing this Form *
Your answer
Last Name of Person Completing this Form *
Your answer
Cell Phone Number *
Your answer
Home Phone Number
Your answer
Home Address *
Your answer
Zip Code *
Your answer
Email *
Your answer
First Name of Participant *
Your answer
Last Name of Participant *
Your answer
Age *
Your answer
Gender *
What disability does the participant have? *
Accommodation Being Requested *
Season of Program you Register For *
Name of Program *
Your answer
Course Number *
Course Number can be found on your receipt and under the program description in the Activity Guide Book. Example RP403.501
Your answer
Program Location *
Your answer
Program Start Date *
MM
/
DD
/
YYYY
Program End Date *
MM
/
DD
/
YYYY
Days of Week Program Runs *
Required
Program Start Time *
Time
:
Program End Time *
Time
:
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