2025 Inclusion Support Service Request

To request Inclusion Support Services for a Columbus Recreation and Parks activity, please complete this form. Once submitted, a member of our Therapeutic Recreation staff will reach out in 3-5 business days to set up a meeting.

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Phone
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Type of Accommodation *

Please select all that apply to the camper.

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Does the camper use any medications?*

If yes, please identify the type, dosage, and time of all medications the camper is currently taking.

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Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Please select each statement that applies to the camper. Use the comment section to identify additional needs.

Behavior Management Techniques Used *
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Care Team Contact*

By checking this box, I, hereby give my permission for Columbus Recreation and Parks Inclusion Support staff to exchange and release educational, behavioral, and/or medical information to Recreation and Parks staff and the Care team specified above for the sole purpose of coordinating special accommodations to develop and implement the inclusion support plan for my child. No further information will be given to anyone without my prior written consent. All information will be used to plan appropriate activities for my child.

I acknowledge that by typing my name in the below block, that this serves as a digital signature.