TRPFall 2015 Therapeutic Recreation Program · Fall 2015 Therapeutic Recreation Program MIXED...

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TRP STAFF Allen Beauchamp Adaptive Cycling Specialist (719) 385-6855 [email protected] Felicia Barnhart, CTRS Program Coordinator (719) 385-6964 [email protected] Sarah Braun, CTRS Program Coordinator (719) 385-6855 [email protected] Jacki Mueller Recreation Assistant (719) 385-6965 [email protected] Diane Ridderhoff, CTRS Program Supervisor (719) 385-6958 dridderhoff@springsgov.com Fall Intern Joe Lundquist Metropolitan State University of Denver CONTACT NUMBERS TR Cell for Trips (719) 651-7704 Paralympic Sport Club Cell (719) 200-8427 Sports Office Front Desk (719) 385-5981 WATCH THE TRP VIDEO HERE coloradosprings.gov/tr ARTS AND CULTURE Fall 2015 TRP Therapeutic Recreation Program MIXED EMOTIONS DANCE TROUPE Learn and practice dance steps and creative movement to many types of music! Increase self-confidence and poise by performing in public as a member of the Mixed Emotions Dance Troupe. Colorado Springs Senior Center 1514 N. Hancock Avenue Tuesdays/Thursdays; September 8-December 8 3:30-4:30 p.m.; #6647 Limit: 12 (max.), 10 (min.) Fee: $120 Notes: No class on September 29 due to TRP overnight trip or November 26 due to the Thanksgiving holiday. The Mixed Emotions Dance Troupe will conduct its Annual Holiday Performance on Thursday, December 10; 7:00 p.m. at the Library 21 C, 1175 Chapel Hills Drive during the TRP Arts & Culture Ability Expo. Please note there will be no practice on that date. ADVENTURES IN LEISURE Come take a new adventure with us each month as we explore different cultures, celebrations, customs, and activities. We will be working on crafts, cooking, activities, and a trip now and then. Join the adventure! This class meets various Thursdays of each month. Hillside Community Center 925 S. Institute Thursdays; September 3, 10, October 8, 15, November 5, 12, December 3, 10 9:30-11:30 a.m.; #6648 Limit: 10 (max.), 8 (min.) Fee: $60 DRAMA SERIES Are you interested in drama and the performing arts? Come join our drama workshop led by UCCS Drama graduate, Doug Wolfe. We’ll review the basics of drama as well as learn and prepare for a short play to be performed at the TRP Arts and Culture Ability Expo on Thursday, December 10. Colorado Springs Senior Center 1514 N. Hancock Avenue Mondays; November 2-30 3:00-4:00 p.m.; #6649 Limit: 10 (max.), 8 (min.) Fee: $25 ARTS AND CULTURE ABILITY EXPO Join the Therapeutic Recreation Program for its first Arts and Culture Ability Expo where the TRP will showcase the talents and amazing abilities of participants who are engaged in programs within the core area of Arts and Culture! The evening will begin with a gallery show featuring pieces from the Painting in the Park Series, as well as photos from our photography workshop capturing the scenic views of Crested Butte, CO. Following the gallery show there will be a performance by the Mixed Emotions Dance Troupe as well as a short play from our very own drama group. Mark your calendars now as you will not want to miss this amazing event! Library 21 C, 1175 Chapel Hills Dr. Thursday, December 10 Gallery Showing: 6:00-7:00 p.m. Dance and Drama Performance: 7:00-8:00 p.m. Free Admission - Invite your friends and family *Library 21 C provides a hearing loop for individuals with hearing loss. Switch to T-Coil setting for hearing loop or ask for portable receivers. NEW Fall Registration begins Monday, August 17

Transcript of TRPFall 2015 Therapeutic Recreation Program · Fall 2015 Therapeutic Recreation Program MIXED...

Page 1: TRPFall 2015 Therapeutic Recreation Program · Fall 2015 Therapeutic Recreation Program MIXED EMOTIONS DANCE TROUPE Learn and practice dance steps and creative movement to many types

TRP STAFFAllen Beauchamp

Adaptive Cycling Specialist(719) 385-6855

[email protected]

Felicia Barnhart, CTRSProgram Coordinator

(719) [email protected]

Sarah Braun, CTRSProgram Coordinator

(719) 385-6855 [email protected]

Jacki MuellerRecreation Assistant

(719) [email protected]

Diane Ridderhoff, CTRSProgram Supervisor

(719) 385-6958 [email protected]

Fall InternJoe Lundquist

Metropolitan State University of Denver

CONTACTNUMBERS

TR Cell for Trips(719) 651-7704

Paralympic Sport Club Cell(719) 200-8427

Sports Office Front Desk(719) 385-5981

WATCh ThE TRP VidEO

hEREcoloradosprings.gov/tr

ARTS ANd CULTURE

Fall 2015TRP Therapeutic Recreation Program

MIXED EMOTIONS DANCE TROUPELearn and practice dance steps and creative movement to many types of music! Increase self-confidence and poise by performing in public as a member of the Mixed Emotions Dance Troupe.

Colorado Springs Senior Center1514 N. Hancock AvenueTuesdays/Thursdays; September 8-December 83:30-4:30 p.m.; #6647Limit: 12 (max.), 10 (min.)Fee: $120

Notes: No class on September 29 due to TRP overnight trip or November 26 due to the Thanksgiving holiday. The Mixed Emotions Dance Troupe will conduct its Annual HolidayPerformance on Thursday, December 10; 7:00 p.m. at the Library 21 C, 1175 Chapel Hills Drive during the TRP Arts & Culture Ability Expo. Please note there will be no practice on that date.

ADVENTURES IN LEISURECome take a new adventure with us each month as we explore different cultures, celebrations, customs, and activities. We will be working on crafts, cooking, activities, and a trip now and then. Join the adventure! This class meets various Thursdays of each month.

Hillside Community Center925 S. InstituteThursdays; September 3, 10, October 8, 15, November 5, 12, December 3, 109:30-11:30 a.m.; #6648Limit: 10 (max.), 8 (min.)Fee: $60

DRAMA SERIESAre you interested in drama and the performing arts? Come join our drama workshop led by UCCS Drama graduate, Doug Wolfe. We’ll review the basics of drama as well as learn and prepare for a short play to be performed at the TRP Arts and Culture Ability Expo on Thursday, December 10.

Colorado Springs Senior Center1514 N. Hancock AvenueMondays; November 2-303:00-4:00 p.m.; #6649Limit: 10 (max.), 8 (min.)Fee: $25

ARTS AND CULTURE ABILITY EXPOJoin the Therapeutic Recreation Program for its first Arts and Culture Ability Expo

where the TRP will showcase the talents and amazing abilities of participants who are engaged in programs within the core area of Arts and Culture!

The evening will begin with a gallery show featuring pieces from the Painting in the Park Series, as well as photos from our photography workshop capturing the scenic views of Crested Butte, CO.

Following the gallery show there will be a performance by the Mixed Emotions Dance Troupe as well as a short play from our very own drama group.

Mark your calendars now as you will not want to miss this amazing event!

Library 21 C, 1175 Chapel Hills Dr.Thursday, December 10

Gallery Showing: 6:00-7:00 p.m.Dance and Drama Performance: 7:00-8:00 p.m.Free Admission - Invite your friends and family

*Library 21 C provides a hearing loop for individuals with hearing loss. Switch to T-Coil setting for hearing loop or ask for portable receivers.

NEW

Fall Registration begins Monday, August 17

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SOCiAL ENRiChMENT

COMMUNiTY iNTEGRATiON/

LEiSURE EdUCATiONC.O.S. CLUB Creating Opportunities for ServiceThe C.O.S Club is all about coming together to help people in need and having fun while doing it! Whether it is packaging a meal, cleaning a park, or covering up graffiti we will get the job done. Club meets first two Fridays of the month.

Colorado Springs Senior Center, 1514 N. Hancock Ave.Fridays, September 4, 11, October 2, 9, November 6, 13, December 4, 111:30-4:00 p.m.; #6655Limit: 10 (max.) 8 (min.)Fee: $74

Note: Specific projects and locations will be available after regis-tration.

OUTdOORAdVENTURE

OVERNIGHT PHOTOGRAPHY WILDERNESS TRIPfor persons with Intellectual/Developmental Disabilities

Online registration is NOT available for this activity; drop-off or mail-in only.Experience the autumn beauty of Crested Butte, Colorado! Join us as we head to the Adaptive Sports Center (ASC) for a 3 day, 2 night trip. The focus of this trip will be about photography - learning how to take great pictures of the beautiful colors, hiking on various trails, and leisurely enjoyment in the town of Crested Butte.

Depart and Return to the Colorado Springs Senior Center, 1514 N. Hancock Ave.Monday-Wednesday, September 28-30; #6660Limit: 8 (max.), 6 (min.)Fee: $200

Notes: More information and paperwork will be provided after registration. Lodging and all meals will be provided by the ASC. Please contact the TRP office if you qualify for an adjusted fee.

OUT ON THE TOWN DANCECome and socialize with old friends and new while you dance the night away. Dressing according to the theme encouraged, but not required. Please do not arrive before 6:30 p.m.

Colorado Springs Senior Center, 1514 N. Hancock Ave.7:00-9:00 p.m.September 18 Denim Dance; #6650October 16 Ghoulish Gala; #6651November 20 Turkey Tango; #6652December 18 Jingle Bell Party; #6653Limit: 100 (max.), 80 (min.)Fee: $5/night

NEW GUIDELINESAs the Dance continues to grow the TRP has put the following guidelines in place in order to create a safe and fun environment: • All persons entering the building must check in at

registration table; • participants must pay the $5 entrance fee and receive a

name tag; • hanging out in the lobby without paying is not permitted; • caregivers are also required to wear a name tag but are not

required to pay; • proper social and physical behavior is expected during the

dance; • if a participant’s behavior is harmful to self or others

(inappropriate verbal communication, hitting, self-abuse) or refusal to stay with the group or adhere to TRP staff recommendations, participants may be asked to leave.

TEEN DANCECome dance the night away with your friends. The fee includes live music, snack, drink, and door prizes. Doors will open at 6:30 p.m. Parents/caregivers are encouraged to stay with no charge. Please do not arrive before 6:00 p.m. This dance is for teens ages 13-18.

Colorado Springs Senior Center, 1514 N. Hancock Ave.Friday, September 25 6:30-8:30 p.m.; #6654Limit: 50 (max.), 25 (min.)Fee: $5

Notes: Pre-registration is required for this activity. Registration deadline is September 11.

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AIR FORCE ACADEMY STADIUM TOURNewcomers to the USAFA Falcon Stadium will see it as one of the premier college football stadiums in America. Join us on a guided tour of the stadium.

Tuesday, September 15; #6656Limit: 12 (max), 10 (min.)Fee: $20

Notes: This Jaunt is from 11:00 a.m.-2:30 p.m. Please wear walking shoes and dress for being outside. Bring a lunch and we will sit outside of Falcon Stadium and eat lunch.

GEORGETOWN LOOP RAILROADEnjoy a fun-filled day with a great view of Georgetown as we take a train tour through the town. We will spend time in the park enjoying lunch in the outdoors.

Tuesday, October 6; #6657Limit: 12 (max.) (10 min.)Fee: $41.95 (includes train ticket)

Notes: This Jaunt is from 9:45 a.m.-4:00 p.m. Please dress in warm clothes as the train is not fully enclosed. We will be eating lunch at the park, so please bring a lunch with you.

DENVER FIREFIGHTERS MUSEUM The Denver Firefighters Museum has been housed in the original Firehouse Number 1 since 1909. Come explore over a century of historical artifacts, fascinating exhibits, and fun activities throughout the Museum. There will be a guided tour provided by a retired firefighter.

Tuesday, November 10; #6658Limit: 12 (max.) 10 min.)Fee: $22

Notes: This Jaunt is from 10:00 a.m.-3:00 p.m. Please wear walking shoes and bring money for a restaurant in Denver.

GLEN EYRIE CASTLE TOURGlen Eyrie is an English Tudor-style castle built by General William Jackson Palmer, the founder of Colorado Springs. Come along with us as we receive a guided tour of the castle and enjoy the beauty of Colorado Springs in December.

Tuesday, December 8; #6659Limit: 12 (max.) (10 min.)Fee: $29

Notes: This Jaunt is from 8:45 a.m.-12:45 p.m. Please dress warm with a hat, gloves, and a jacket. Please bring money for lunch at Rudy’s BBQ after the tour.

dAYTiME JAUNTSFOR ADULTS AGES 18 AND OLDER

All trips depart from the Colorado Springs Senior Center, 1514 N. Hancock Ave. unless noted. All trips are limited to four wheelchairs.

Online registration is NOT available for these activities; drop-off or mail-in only.

ThERAPEUTiC RECREATiON PROGRAM

POLiCYIt is the goal of the Therapeutic Recreation Program

to provide a positive, safe, and fun recreation experience for all individuals. To provide you with the best possible experience, we have developed the following policies:

Appropriate social behavior is stressed during all programs. The staff and volunteers will do their best to ensure each participant’s success in the programs. If a participant’s behavior is detrimental to the group or self (kicking, biting, hitting, self-abusing, refusal to stay with the group, etc.), a parent or guardian will be called to pick up the participant immediately. Please call the TR Office if you have any questions.

Please note specific trip arrival and departure times. All trips will wait a maximum of 15 minutes before departing. Upon return, all participants must be picked up within 15 minutes. If you know you will be late, call the cell phone at (719) 651-7704. Please be considerate of the group.

Note that each program activity has a list of maximum and minimum numbers for enrollment. If the maximum numbers have been reached, a wait list will be initiated and those individuals will be contacted when there is an opening. If the minimum numbers are not reached, the class will be canceled.

Because we attempt to accommodate as many people as possible, if you cannot participate in a scheduled program, please call to cancel as soon as possible so we can contact the participants on the wait list. Your consideration is appreciated.

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Fall Registration begins Monday, August 17

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SPORTS, FiTNESS & AQUATiCSFOR ADULTS WITH INTELLECTUAL/DEVELOPMENTAL DISABILITIES

Are you looking to stay active and want to find a group to help keep you accountable to keep moving? Then consider joining the Achilles group.

Achilles is essentially an all-inclusive running/walking/moving group open to people of all abilities and ages that meets once a week in Colorado Springs. For more information visit their website at http://www.achillesinternational.org

FOOT GOLFJoin us as we try out one of the newest sports in Colorado Springs - Foot Golf, a combination of golf and soccer, but you use soccer balls on a golf course with larger holes! The rules are similar to golf, but include a fun twist! Instructors from Valley Hi Golf Course will be on hand to assist with instruction and rules of play.

Valley Hi Golf Course, 610 S. CheltonWednesday, September 23 1:00-3:00 p.m.; #6661Limit: 8 (max.); 6 (min.)Fee: $9

Notes: This activity does involve walking on the course. Please wear tennis shoes or golf shoes, and bring a water bottle, hat, and sunscreen.

CYCLINGThe TRP is again partnering with local bike specialist, Cycle Different, to offer an opportunity for participants to try a variety of adaptive cycles on a short trail ride. Cycles and helmets are provided.

Criterium Bike Trail (in Memorial Park)Monday, September 21Session 1: 12:00-1:30 p.m.; #6662Session 2: 1:30-3:00 p.m.; #6663Limit: 4 (max.); 2 (min.)Fee: $5

Note: Meet at the Criterium bike trail across from the velodrome in Memorial Park.

BUBBLE BUMP SOCCERMeet us at Memorial Park, and try the crazy, new sport of Bubble Bump Soccer - soccer played in an inflatable bubble! Staff from Gravity Play will be on hand to provide instruction for a bouncing, bumping afternoon! Participants do not need to know how to play soccer in order to participate. Equipment is provided.

Memorial Park Rosebowl (meet at the Sports & Therapeutic Recreation Office)Monday, September 142:00-4:00 p.m.; ##6664Limit: 8 (max.); 6 (min.)Fee: $25

Notes: Meet at the Sports & Therapeutic Recreation Office, 1315 E. Pikes Peak Ave. Please wear comfortable clothing, tennis shoes, and bring a bottle of water and sunscreen.

INNER TUBE WATER POLOJoin us in the pool for a fun way to play water polo without swimming! Participants will learn basic rules of play, how to move in a tube, and have opportunities to scrimmage each other. Participants do not need to know how to swim in order to participate, but must be comfortable in the water. Equipment is provided.

Memorial Park Swimming Pool, 280 S. Union Blvd.Mondays, October 5-262:30-3:30 p.m.; #6665Limit: 12 (max.); 10 (min.)Fee: $25

YOGAJoin us for an integrative approach to wellness while enjoying movement, physical stimulation, and awareness relaxation techniques. Stacie Wyatt, certified yoga instructor and founder of Embracing Spirit Yoga, will return to instruct introductory yoga poses, total body stretches, and aromatherapy. Exercises can be performed sitting, standing, in a wheelchair, or on the floor.

Colorado Springs Senior Center, 1514 N. Hancock Ave.Wednesdays, October 7- November 184:15-5:00 p.m.; #6666Limit: 10 (max.), 8 (min.)Fee: $25

Notes: This session consists of a six week series; no class on November 11 due to the Veterans’ Day Holiday. Wear comfortable workout clothes and bring a water bottle. Exercise mats are provided or you may bring your own.

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BACK BY POPULAR dEMANd!

Fall Registration begins Monday, August 17

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SPORTS, FiTNESS & AQUATiCSFOR ADULTS WITH PHYSICAL DISABILITIES

Classes in this and the Paralympic Sport section are specifically designed for individuals with physical disabilities,e.g., stroke, spinal cord injury, multiple sclerosis, brain injury, etc.

AQUA-REHABChallenge yourself to a stretching and strengthening water workout three times a week. Activities will be geared to gradually improve stamina, increase flexibility, and strengthen muscles. The class will be adapted to the ability level of the participants, but may include water walking and deeper-water aerobic workouts.

Memorial Park Swimming Pool, 280 S. Union Blvd.Mondays/Wednesdays/Fridays; 10:00-11:00 a.m.September 14-October 2; #6667October 5-30; #6668November 2-25; #6669November 30-December 18; #6670Limit: 18 (max.), 12 (min.)Fee: $40/session $20 for first session (Sept. 14-Oct. 2) $30 for the final session (Nov. 30-Dec. 18)

Notes: Participants must have a current year physician prescription. No classes on August 31-September 11 (due to pool closure), September 28 and 30 (due to TRP overnight trip), and November 11 and 27 (for City Holidays).

YOGAJoin us for an integrative approach to wellness while enjoying movement, physical stimulation, and awareness relaxation techniques. Stacie Wyatt, certified yoga instructor and founder of Embracing Spirit Yoga, will return to instruct introductory yoga poses, total body stretches, and aromatherapy. Exercises can be performed sitting, standing,in a wheelchair, or on the floor.

Colorado Springs Senior Center, 1514 N. Hancock Ave.Wednesdays, October 7- November 18 3:15-4:00 p.m.; #6671Limit: 10 (max.), 8 (min.)Fee: $25

Notes: This session consists of a six week series. No class on November 11 due to the Veterans Day Holiday. Please plan to attend each class. Wear comfortable workout clothes and bring a water bottle. Exercise mats are provided or you may bring your own.

ADAPTIVE GOLFJoin us for the Fall session of Golf! All lessons will be taught by a golf professional, who will provide individualized instruction for chipping, putting, and driving techniques. Two Golf Xpress carts (a single rider machine), donated by Golf 4 the Disabled, will be available for individual use.

Meet at Patty Jewett Golf Course, 900 E. Espanola St.Tuesdays, September 1-299:00-10:00 a.m.; #6672Limit: 6 (max.), 5 (min.)Fees: $22 $30 check payable to “Golf 4 the Disabled”

Notes: Please bring a water bottle and wear sunscreen. This program is geared for individuals with neurological disabilities and orthopaedic injuries.

CHICk-FIL-A’S PATRIOTS’ FESTIVALThe Walk, Run and Ride for Heroes kicks off the 5th Annual Chick-Fil-A Patriots’ Festival.

It features a free community festival with free Kids Zone,live music, patriotic ceremony and hero demonstrations.

The event will be held Saturday, September 12, 2015 at Mountain Shadows Park. To register for the Walk, Run and Ride for Heroes,

go to www.patriotsfestival.com or call (719) 650-5114.

Chick-Fil-A’s Ride, Run & Walk for Heroes and Patriots’ Festival is to honor those who put themselves

in harm’s way to serve our country and our community.

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PARALYMPiC ACTiViTiESBOCCIA This specialized sport of dedication and precision is open to youth and adults ages 6 and older with cerebral palsy, brain injury, muscular dystrophy, stroke nd multiple sclerosis. There will be opportunity for match play and in-house competition. Due to popular demand, two sessions will be offered. Sign up for one or both sessions!

Colorado Springs Senior Center, 1514 N. Hancock AvenueTuesdays; 3:30-4:30 p.m.Session 1: September 8- October 27; #6673Session 2: November 3-December 15; #6674Limit: 6 (max.), 4 (min.)Fee: $36

Note: No class on September 29 due to TRP overnight trip.

BOCCIA TOURNAMENTInterested in more boccia competitions? Join us for the 2nd Annual Colorado Front Range Boccia Tournament! The tournament will provide an opportunity for participants to compete against individuals from other Paralympic Sport Clubs along the Front Range. The tournament is open to youth and adults ages 6 and older with cerebral palsy, brain injury, muscular dystrophy, stroke and multiple sclerosis.

Location and times TBDSaturday, December 5; #6675Limit: 18 (max.), 10 (min.)Fee: $10

Notes: The TRP cannot guarantee participation of athletes from other Paralympic Sport Clubs. Invitations to the tournament will be shared with staff from various adaptive sport programs.

ADAPTIVE CYCLING RIDESIncentive for Cycling

Participate in 10 rides in 2015/2016 and earn an exclusive cycling shirt from the TRP!

The TR Program is again partnering with local bike specialist, Cycle Different, to host weekend cycling rides on the area bike trail system for individuals with a physical disability. Please bring your own cycle if you have one. If you need a bike, Cycle Different will have cycles available for sign-out prior to each date, including recumbent trikes, handcycles, and upright bikes. Pre-registration is required for each single ride date below. Beginner or veteran riders are welcome!

1483 Garden of the Gods Rd.Saturdays; 9:00 a.m.-1:00 p.m.• September 26; #6676• October 10; #6677

Saturdays; 1:00-3:30 p.m.• October 24; #6678• November 14; #6679

Limit: 12 (max.), 9 (min.)Fee: $9/date

WHEELCHAIR BASkETBALL Interested in learning to play wheelchair basketball? Join us this season on select dates for wheelchair basketball skills sessions. Sessions are open to youth and adults with a physical disability ages 10 and older who are able to move independently in a wheelchair; you do not have to be a wheelchair user to participate.

Panorama Middle School, 2145 S. Chelton Rd.Thursdays, October 15, 22, November 12, 19, December 3, 176:30-8:00 p.m.; #6680Limit: 8 (max.), 4 (min.)Fee: $25

Note: A limited number of sport chairs are available; if you have your own chair, please bring it with you.

INDOOR SHOOTING This program will introduce participants to the competitive sport of shooting at the indoor range of the Olympic Training Center. Participants will learn the basics of air rifle and air pistol use, proper shooting form, scoring, and opportunities for in-house competitions. Coaches from USA Shooting and the National Training Center Shooting Club will be on hand to provide instruction. Equipment will be provided.

Olympic Training Center Shooting Range (lower range)1 Olympic PlazaWednesdays, October 7-287:00-9:00 p.m.; #6681Limit: 8 (max.), 6 (min.)Fee: $75

Notes: USA Shooting and National Training Center Shooting Club forms will be available upon registration. Fee includes a one-year membership to USA Shooting and the National Training Center Shooting Club.

ARCHERYThis four week program will be conducted at Razor Edge Archery. It will provide the opportunity for individuals with physical disabilities to expand their archery skills as well as physical health, focus, and attention skills. Beginner and experienced archers are welcome to participate.

Razor Edge Archery, 2660 Vickers Dr. Wednesdays, October 28-November 251:00-3:00 p.m. #6682Limit: 8 (max.), 4 (min.)Fee: $60

Notes: Equipment will be provided, however if you have your own bow please bring it with you. No class November 11 due to the Veteran’s Day holiday.

Fall Registration begins Monday, August 17

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REGiSTRATiON FORMParticipant Name: Age: Birthdate: Gender: mMale mFemale

Address: City: Zip:

Primary Phone: Other Phone: Email:

Active Military: Veteran: Disability:

Parent/Guardian Name:

Type of Living Situation (choose one): mFamily mIndependent Living mGroup Home mSupervised Apt. mOther

Emergency Contact/Relationship: Phone:

List Medications: Does participant need supervision/assistance with taking medications? mYes mNo

Diet Restrictions (list):

Check those that apply: mAsthma mDiabetes mTube Feeding mAllergies (type: ) Epi Pen required: mYes mNo

Is the participant subject to seizures? mYes mNo Type: Frequency:

Doctor’s Name: Phone:

Assistive equipment and/or physical restrictions:

Other pertinent information in regards to safety and behavioral concerns:

Other information that may enhance the quality and safety of recreation participation:

m Yes m No I hereby give permission for photographs, stories and recordings of myself and/or my child to be used for educational or promotional purposes for PR&CS.

m Yes m No Registrant has authorization to ride the PR&CS buses for TR field trips.

m Yes m No CONSENT TO CONTACT AND RELEASE INFORMATION: I grant permission to the TRP contact school, teacher, physician, employer and/or provider for the purpose of gathering or releasing information regarding the participant. The information will be used to implement the most effective plan in providing therapeutic recreation and inclusion services. All information will be kept confidential.

WAIVER OF LIABILITY AND RELEASE OF ALL CLAIMS: Please read this form carefully and be aware in registering yourself or your minor child/ward for participation in the City of Colorado Springs Therapeutic Recreation Program, you will be waiving and releasing all claims for injuries you or your minor child/ ward might sustain arising out of said program(s). I recognize and acknowledge that there are certain risks of physical injury to participants in a program, and I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program. I agree to waive and relinquish all claims I or my child/ward may have as a result of participating in the program against the City of Colorado Springs Therapeutic Recreation Program and its officers, agents, servants and employees. I do hereby fully release and discharge the City of Colorado Springs Therapeutic Recreation Program and its officers, agents, servants, and employees from any and all claims from injuries, damage, or loss which I or my minor child/ward may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with the activities of the program. I further agree to indemnify and hold harmless and defend the City of Colorado Springs Therapeutic Recreation Program and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me or my minor child/ward arising out of, connected with, or in any way associated with the activities of the program. In the event of any emergency, I authorize the City of Colorado Springs Therapeutic Recreation Program to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for me or my minor child/ward’s immediate care and agree that I will be responsible for payment of any and all medical services rendered. I have read and fully understand the Program Details, Waiver and Release of All Claims and Permission to Secure Treatment.

PLEASE SIGN. EACH REGISTRATION FORM MUST BE SIGNED.Participant/Parent/Guardian: Date:

a Activity Name # Fee

ARTS & CULTUREMixed Emotions Dance Troupe 6647 $120

Adventures in Leisure 6648 $60

Drama Series 6649 $25

SOCIAL ENRICHMENTOut on Town Dance: Sept. 18 6650 $5

Out on Town Dance: Oct. 16 6651 $5

Out on Town Dance: Nov. 20 6652 $5

Out on Town Dance: Dec. 18 6653 $5

Teen Dance: Sept. 25 6654 $5

COMMUNITY INTEGRATION/LEISURE EDUCATION

C.O.S. Club 6655 $74

a Activity Name # Fee

SPORTS, FITNESS & AQUATICS Physical Disabilities

Aqua-Rehab: Sept. 14-Oct. 2 6667 $20

Aqua-Rehab: Oct. 5-30 6668 $40

Aqua-Rehab: Nov. 2-25 6669 $40

Aqua-Rehab: Nov. 30-Dec. 18 6670 $30

Yoga 6671 $25

Adaptive Golf+ $30 to Golf 4 the Disabled 6672 $22

Boccia: Sept. 8-Oct. 27 6673 $36

Boccia: Nov. 3-Dec. 15 6674 $36

Boccia Tournament 6675 $10

Adaptive Cycling: Sept. 26 6676 $9

Adaptive Cycling: Oct. 10 6677 $9

Adaptive Cycling: Oct. 24 6678 $9

Adaptive Cycling: Nov. 14 6679 $9

Wheelchair Basketball 6680 $25

Indoor Shooting 6681 $75

Archery 6682 $60

a Activity Name # Fee

OUTDOOR ADVENTURESIntellectual/Developmental Disabilities

Overnight Photography Wilderness Trip 6660 $200

DAYTIME JAUNTSAFA Stadium Tour 6656 $20

Georgetown Loop Railroad 6657 $41.95

Denver Firefighters Museum 6658 $22

Glen Eyrie Castle Tour 6659 $29

SPORTS, FITNESS & AQUATICS Intellectual/Developmental Disabilities

Foot Golf 6661 $9

Cycling: Noon-1:30 p.m. 6662 $5

Cycling: 1:30-3:00 p.m. 6663 $5

Bubble Bump Soccer 6664 $25

Inner Tube Water Polo 6665 $25

Yoga 6666 $25

Page 8: TRPFall 2015 Therapeutic Recreation Program · Fall 2015 Therapeutic Recreation Program MIXED EMOTIONS DANCE TROUPE Learn and practice dance steps and creative movement to many types

HOW TO REGISTERComplete the information for each class on the Therapeutic Recreation Program Registration Form.

WHERE TO REGISTERMail your registration form to or register in-person at:

Therapeutic Recreation Program1315 East Pikes Peak AvenueColorado Springs. CO 80909

WHEN TO REGISTER Monday, August 17, 20158:00 a.m.-5:00 p.m.All mail-in and drop-off registrations will be placed in a box. At the end of each day, registrations will be randomly drawn until the classes are filled or all registrations are drawn. A receipt will be sent to you in the mail to confirm your enrollment in the class.

PAYMENTTo reserve a spot in the program, one-half of each class fee must accompany the registration form. Payment-in-full must be made by the first day of class. Make checks payable to Recreation Services.

ADJUSTED FEESPayment Plans and Adjusted Fees are available for classes exceeding a registration cost of $25. Trip fees do not qualify. Please contact the TRP Supervisor for additional information.

CANCELLATIONSIf a class is canceled due to lack of registration, you will be notified and may choose to:

• enroll in another activity• obtain credit toward other activities• receive a full refund

REFUND POLICYA refund or credit for classes/activities will not be issued once registration has occurred. If withdrawal from the class/activity is for a medical reason or due to a move from the Pikes Peak region, a pro-rated credit or refund will be issued from the start date up to the mid-point of the class/activity. No refund or credit will be issued after 50% of the class/activity has been completed.

A full refund or credit will be issued if Parks, Recreation & Cultural Services cancels a class/activity. When requesting a refund, please specify refund check or credit to your account. Allow 2 weeks for a refund check.

REGiSTRATiON iNFORMATiON

PROGRAMTHERAPEUTIC RECREATION

parks ∙ recreation ∙ cultural services

SPRINGSCOLORADO

coloradosprings.gov/TR