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Western DuPage Special Recreation Association

2010
Fall Brochure

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REGISTER ONLINE NOW

click here to view
the summer 2010 brochure

Inclusion Notification Form

Questions regarding this from should be directed to Tammy Kerrins at (630) 681-0962
or e-mail tammyk@wdsra.com

Submitted by E-mail Address (for confirmation)
Park Dist Staff
Parent/Guardian
Date Submitted
Season
 Year
Participant's Name
Date of Birth
Male
Female
Parent's Name

Phone Number
Zip
Address
City
Parent email
Park District Supervisor
Program Title Program Number
Program Location (include Rm #)
Day of Week Time
Date Program Begins
Date Program Ends Does not meet on:
Minimum Age
 Maximum Age Staff/Participant Ratio
Name of Instructor
 Class Prerequisites?
Equipment/Supplies Needed
 
Please indicate which type of assistance is requested:
   
Training
 Observation Additional Staff Modified Equipment Other  
   
Additional Comments
 
     
  Are Parents Aware of WDSRA Services?
     

 

Charlie Long/
WDSRA Golf Classic
Tues, July 20
Arrowhead G.C.

golf ball pic

Thank You for Your Support


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