Inclusion Information Form
Since 2019, we have been striving to streamline consistency, care & support of Larkin’s Place Friends across all Stephens Family YMCA arenas.  In effort to do that, we are asking that you would fill out an Inclusion Form that we may update as needed on a yearly basis.  This is will be implemented at the time of registration for membership and programs asking the question of “Do you require an accommodation or modification due to a disability to participant? Check: Yes or No .”  
       From that question we hope to provide those with an opportunity to share what would help them feel included and successful in their visits to the YMCA. It is after the submission of the this form that we will be better able to communicate consistency among staff  that serve members and program participants.   We are strongly committed to making Larkin’s Place the place where all members can be accept, play, and grow in the YMCA.  If you have questions or concerns or would like to start filling out the inclusion/accommodation form, please email
Sign in to Google to save your progress. Learn more
Participant's Name *
Participant's diagnosis (if known)
School District Participant attends (if applicable)
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy