Willamalane Accommodations Request
Please be aware we will conduct a review and initial assessment by contacting the patron prior to the beginning of the program. Staff will create an accommodations plan to be implemented. Willamalane Inclusion Services reserves the right to deny a request if a modification are not supported by the data in the assessment or documentation, the patron does not meet the essential eligibility criteria the request does not fall under the requirements of the Americans with Disabilities Act.

Personal Care:
All participants must be able to conduct services of a personal nature (feeding, dressing, toileting) independently. Staff are not required to assist participants preform services of a personal nature. If a participant requires personal care a caregiver may attend with the participant. For more information please contact the Inclusion Services Supervisor.

Medications:
Willamalane Park and Recreation District staff can administer medication as long as it is in an original container. We require participants to fill out a separate Medication Administration Form. Staff will log all medication administration.

Care Providers:
Anyone supporting a participant with accommodations and support needs can receive free entrance to the program or facility. Individuals must pass the Willamalane Volunteer process including two background checks. For more information please contact the Inclusion Services Supervisor.

Non– Discrimination:
We do not discriminate on the basis of race, creed, color, national origin, sex, age or disability.

Unsafe Behaviors:
Willamalane reserves the right to remove that participant from the program and may also choose to deny the participant from other programs until documentation is available to prove the behavior is no longer a safety threat. Safety threats include running away, being physically aggressive towards staff, others and self, and gross inappropriate behavior that cannot be mitigated nor controlled. In some cases the Inclusion Supervisor can make the decision to immediately suspend a participant if gross inappropriate behavior occurs. Please refer to the inclusion manual for additional information on unsafe behaviors.


Email address *
Patron First Name *
Your answer
Patron Last Name *
Your answer
Guardian First Name *
Your answer
Guardian Last Name *
Your answer
Contact Phone Number *
Your answer
Contact Email *
Your answer
Name of Person Requesting Accomodation
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Relationship to the Patron
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Age of Patron Needing Accomodations *
Your answer
Program/Event/Facility you are requesting accommodations for *
Your answer
Location of Program/Event/Facilty *
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Date(s) of Accommodation(s) *
Your answer
Describe the support/ or modification you are requesting; please be specific *
Your answer
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