Adaptive and Inclusive Recreation (AIR) Summer activities 2015

18
Adaptive and Inclusive Recreation (AIR) Summer 2015 Commissioner Amanda Fritz Director Mike Abbaté REGISTRATION BEGINS APRIL 20, 2015 Go to PortlandParks.org, click on the Register Now tab. • Trips – Thursdays & Saturdays... see pages 7-11 • Cooking Offered in September... see page 6 • CAMPS! Skate: grades 2-6 & Teen Explorer: ages 13 - 21.. see page 4

description

The Adaptive and Inclusive Recreation (AIR) program offers community-based recreation activities and leisure services specially designed for youth through adults who have a disability or special need. Our services assist people to develop and use their leisure time in ways to enhance their health, independence and well-being.

Transcript of Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Page 1: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Adaptive and Inclusive Recreation (AIR)

Summer 2015

Commissioner Amanda FritzDirector Mike Abbaté

RegistRAtiON BegiNs ApRil 20, 2015Go to PortlandParks.org, click on the Register Now tab.

• Trips–Thursdays&Saturdays... see pages 7-11• CookingOfferedinSeptember... see page 6 • CAMPS!Skate:grades2-6&TeenExplorer:ages13-21.. see page 4

Page 2: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Portland Parks & Recreation

2 Adaptive and Inclusive Recreation 503.823.4333

TABLEOFCONTENTSInclusion Services ................................................. 3Camps ................................................................... 4Drop-in Classes ..................................................... 5Special Interest Classes ......................................... 6Exercise ................................................................. 6Adult Outings ................................................... 7-11Summer Free For All .....................................12-14Registration Information ................................15-17

Hours: Monday through Friday, 9:00am-5:00pmClosed: July 3rd – Fourth of JulyRec. Coordinator II: Jane Doyle E-mail: [email protected]. Coordinator I: Chantelle KingE-mail: [email protected] Rec. Coordinator I: Becky BechtellE-mail: [email protected]

Bus Lines: #70, 12th Ave. Bus #12, #19, #20 and MAX are within three blocks.

Parking: On-street or Portland Tennis Center

Disabled Access: Entrances: Accessible Parking: Accessible. Designated spot in the Tennis Center parking lot and on-street in front of the outdoor tennis courts by the AIR office. Restroom: Accessible Note: The office is not adjacent to the parking lot or street. Call office for directions.

Adaptive and

Inclusive Recreation (AIR)

426 NE 12th Ave.Portland, OR 97232

Telephone: 503-823-4333FAX 503- 823-4329Oregon Relay - 711

Page 3: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 3

Portland Parks & Recreation

Within the Americans with Disability Act (ADA) of 1990, Portland Parks & Recreation (PP&R) provides accommodations to individuals with disabilities/special needs, so that they may receive an equal opportunity to participate in programs offered citywide.

How it Works1. Choose the activity you would like to participate

in, and then access the PP&R site to know where the activity is being offered.

2. Register for the activity. You can do this in person at a PP&R site, or online at

www.PortlandParks.org. When registering, let the person know you will need accommodations in order to participate in the activity (online, check the box.)

3. Once registered, please contact Inclusion Services at 503-823-4333. If this is your first accommodation through Inclusion Services, you will need to do a phone intake with a staff member. At the end of the phone intake, it will be determined whether an assistant will be needed on the first day of the activity to provide on-site support. Future assistance will be provided based on need. The inclusion staff will work with the instructor on how to support you and your individual needs.

ImportantDetailsA general program may be adapted using auxiliary aids and services, but the basic structure of the program remains the same. Accommodations are made as needed, and can be flexible as well as creative. Participants need to register for activities that are intended for their birth age. Personal care is provided for activities in the pre-school and youth category, up through age 12.

If you have questions about Inclusion Services, please call 503-823-4333 or 711 (TRS). A minimum of 10 business days (Monday-Friday) advance notice is required. The Inclusion Services staff will do their best to accommodate each participant.

INCLUSIONSERVICESFORPEOPLEWITHSPECIALNEEDS

View and register for classes on-line at www.PortlandParks.org or call the

Customer Service Center at 503-823-2525.Fall 2015August 17

Summer 2015April 20

CALENDAR

Portland Parks & Recreation MissionPortland Parks & Recreation is dedicated to ensuring access to leisure opportunities and

enhancing Portland’s natural beauty.

AiR MissiON stAteMeNtThe Adaptive and Inclusive Recreation (AIR) program offers community-based recreation activities and leisure services

specially designed for youth through adults who have a disability or special need. Our services assist people to develop and use their leisure time in ways to enhance their

health, independence and well-being.

WITHDRAWAL&REFUNDINFORMATION

WItHDRAWALS & ReFunDS: Please notify us at least five (5) business days (Monday-Friday) before the start of your program so that we can refund or credit your account for the registration fee. Refunds will not be given without enough notice. Pre-paid materials and admission tickets cannot be refunded.

Refund request time frame requirements

1st Day of activity Latest time of notification

Monday Prior Monday at noon

Tuesday Prior Thursday at noon

Wednesday Prior Wednesday at noon

Thursday Prior Thursday at noon

Friday Prior Friday at noon

Saturday Prior Monday at noon

Sunday Prior Monday at noon

Page 4: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Portland Parks & Recreation

4 Adaptive and Inclusive Recreation 503.823.4333

Adaptive skateboarding Camp @ glenhavenSet & reach new skateboarding goals while building healthy confidence on your board! This camp provides recreational opportunities for youth with physical disabilities, siblings and friends. Learn about skate park etiquette, safety practices, & skateboarding fundamentals. Improve balance, mechanics, riding skills & control. Get up, get excited! Let’s skate!Location: Glenhaven Park - Skate Park

teen explorer CampThis exploratory day camp is designed for teens with special needs. Every day is a different outdoor adventure around the metropolitan area. Participants will explore nature along accessible trails in Portland’s Parks & Natural Areas. Activities include games, crafts, and stewardship possibilities. Contact the Adaptive and Inclusive Recreation Office at 503-823-4333 for more information.Location: Interstate Fire House 5340 N Interstate

Coarse #: 1026273Date: Monday - Friday, July 6 - 10Time: 9:00 am - 12:00 pmCost: $60

Coarse #: 1027695Date: August 17 - August 21Time: 9:00 am - 3:00 pmCost: $220 Resident / $286 Non-Resident

Summer Camps

Page 5: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 5

Portland Parks & Recreation

Bowling For Fun Age: 10 - AdultWhoop it up with your friends while knocking down pins. Beginners through advanced are welcomed. Bring $5 for one game or $10 for two. To accommodate bowlers who wish to play every week and don’t want to hassle with bringing money each time, we offer a 20 game punch card for $100.Shoes are free. Pre-registration is not required. Adaptive bowling equipment is available at the lanes. Drop-in activityDate: Wednesday, July 1 - September 30time: 3:00pm - 4:30pm

Location:20th Century Lanes

3350 SE 92 (cross street Powell)Bus #9 and MAX

Mt. Scott Community Center5530 Se 72nd

(four blocks south of Foster Blvd.)Bus #10 and #14

Cost - $5Age 16 - Adult

1st Friday of the month

May 1st & June 5th

Have fun dancing to a DJ or a band. Socialize with friends, both old and new. Refreshments

are provided. Cost for participants is $5. Facility staff and parents are free, but donations are kindly accepted to help with the cost. Group and foster

home staff must stay to assist their participants in the dance unless prior arrangements have been

made with AIR by calling 503-823-4333.

Due to the large number of participants who attend the dance, AIR staff is only able to supervise

participants who are in the auditorium, social room or the hallway of the center. Staff is unable to

provide assistance to participants who need close supervision or personal care in the restroom.

DROP-INCLASS

Page 6: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Portland Parks & Recreation

6 Adaptive and Inclusive Recreation 503.823.4333

SPECIALINTERESTCLASSESCooking with FriendsFood and friends make great meals! Test and taste recipes that you can make again at home Find something new to cook as you gain confidence in the kitchen and build a cookbook to record your class experiences.Montavilla Community Center8219 NE GlisanInstructor: Cheryl TruongCoarse #: 1028734Date: Thursdays September 3 - October 1time: 5:30pm - 7:00pmCost: $50

Yoga In ChairsDesigned so almost anyone can participate. Gently works muscles & joints to enhance strength, range of motion, balance & circulation. Feel relaxed, refreshed & re-energized.east Portland Community Center740 SE 106Instructor: Carolyn BochCoarse #: 1028735Date: Tuesday September 1 - 22time: 4:15pm - 5:15pmCost: $28

Scholarships: City of Portland residents and non-residents, regardless of age, who require financial assistance can apply for partial scholarships for AIR activities. ContactAIRat503-823-4333.

Meet Us There! Friends, Food, & Fun

Page 7: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 7

Portland Parks & Recreation

*St Paul RodeoCome join us for the 80th St Paul Rodeo! We will be checking out the barrel racing, steer wrestling, and bull riding just to name a few of the events. We will also be walking through the booths and listening to some good ole country music! This trip will include a lot of walking and a late night. *This is a non-accessible trip.Coarse #: 1028743Date: Thursday, July 2time: 2:30pm - 11:30pmCost: $45

BullwinklesReady to have 3 hours of unlimited Go Karts, Bumper Boats, Miniature Golf, laser tag, Max Flight Cyber Coaster, Sky trail Ropes and much more. We also will have a $5 arcade card. Cost of trip includes all this, just bring $15 for your lunch.Coarse #: 1028744Date: Thursday, July 9thtime: 9:00am - 3:00pmCost: $52

THURSDAY&SATURDAYADVENTURESAGE:18&up

MeetiNg lOCAtiON All outings leave from the parking lot at PortlandTennisCenter324 NE 12th, across from Franz BakeryThe cross-street is Flanders.Bus #70 stops near the parking lot but doesn’t run until 9:00am on Saturdays. Buses #12, #19, #20 and MAX are within three blocks. For more information on outings, call AIR at 503-823-4333.

Hillsboro Hops Baseball GameCome join us to cheer on the Hillsboro Hops while they take on the Spokane Indians. Hillsboro’s newest Minor league baseball team. Bring money for lunch. Cost of trip includes your ticket to the game.Coarse #: 1028745Date: Saturday, July 11thtime: 3:45pm - 8:45pmCost: $46

Fun In the Coastal SunThe crash of the waves, the smell of the sweet salt air, or the feel of sand between your toes; it is tough not to love going to the beach. Relax & let loose in one of the most beautiful places around, the wonderful Oregon oceanfront. Manzanita Beach will be our destination, after we eat lunch at Nehalem State Park. Explore the beach for rocks, shells & other treasures. A beach wheelchair will be available to use if you feel unsteady in the sand. You will need to be able to transfer to the beach wheelchair on your own. Please bring lunch and $5 for ice cream on the way home.Coarse #: 1028746Date: Thursday, July 16time: 9:00am - 6:00pmCost: $45

Page 8: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Portland Parks & Recreation

8 Adaptive and Inclusive Recreation 503.823.4333

Coastal Primate SanctuaryCome explore the beautiful 28 acre sanctuary where the monkey’s live amongst the trees, birds and deer. Their mission is to take in unwanted monkey’s that need a place to stay and provide life time care. We will be having a picnic lunch at the sanctuary. Bring $10 cash for the admission.Coarse #: 1028747Date: Saturday, July 18time: 9:00am - 2:00pmCost: $28

Mt. St. Helens & Picnic LunchStops at Silver Lake Observatory and Cold Water Lake provide both geologic information and fun exhibits. Experience the constantly changing forces of nature & the incredible eruption chamber. Be amazed at life emerging from the ash through award winning theater presentations. Bring $5 for admission, snacks and a picnic lunch. Mt. St. Helen’s trip operates under a special use permit from the USDA Forest Service.Coarse #: 1028748Date: Thursday, July 23time: 8:45am - 4:45pmCost: $45

Purrington Cat LoungePurrington’s Cat Lounge is the premier petting palace in P-town for kitty lovers that just opened up the first of 2015! They are partnered with Cat Adoption Team. These felines will be in the best spot while waiting to be adopted. Spend the afternoon petting and playing with cats. Bring $15 for lunch. Admission into the lounge is included in the cost of the trip.Coarse #: 1028749Date: Saturday, July 25time: 11:30am - 3:30pmCost: $35

THURSDAY&SATURDAYADVENTURESAGE:18&up

Catch the Big One!Do you like fresh trout? Experience the sensation of catching & eating your own dinner. Improve fishing skills & hook a ‘whopper’ from a stocked pond located in a natural setting. Imagine the fun you’ll have sharing personal fish stories that will surprise friends & family.Coarse #: 1028752Date: Thursday, July 30time: 10:15am - 3:45pmCost: $30

Page 9: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 9

Portland Parks & Recreation

timberline Lodge and Picnic lunchTour the majestic 1930s lodge or relax on the mountainside. Look for Heidi the St Bernard dog! Eat your picnic lunch as you are looking at the breath taking views from the mountain. Bring sack lunch & spending for the gift shop. Coarse #: 1028751Date: Saturday, August 1time: 9:00am - 2:30pmCost: $35

exploring the Sands of Pacific CityExplore the Oregon coast and have lunch at a local restaurant. Sink your toes in the sand or even the Pacific Ocean. Enjoy the beaches with your friends. Bring $20 for lunch and extra spending money for souvenirs. Coarse #: 1028763Date: Thursday, August 6time: 9:00am - 6:00pmCost: $45

Hoyt ArboretumTake a guided tour walk through the accessible trails at the Portland Parks Hoyt Arboretum. Enjoy the sights and sounds offered by the beautiful natural surroundings. Bring a picnic lunch to enjoy on the cedar deck.Coarse #: 1028754Date: Saturday, August 8thtime: 10:00am - 2:00pmCost: $25

THURSDAY&SATURDAYADVENTURESAGE:18&up

Maryhill MuseumSee first hand the unforgettable tour of the Maryhill Museum of Art in Goldendale, Washington. View the international chess set, the elaborate gown of Queen of Romania and check out the American Indian gallery. We will be dining in The Dallas, then heading up to the Museum for our tour. Bring a snack and $20 for lunch and admission.Coarse #: 1028756Date: Thursday, August 13time: 9:30am - 5:00pmCost: $40

Page 10: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Portland Parks & Recreation

10 Adaptive and Inclusive Recreation 503.823.4333

Find us on

at: Adaptive and Inclusive Recreation (AIR) - PP&R

Facebook

It’s Happening At the Oregon Zoo!Sea lions & otters romp for your enjoyment in underwater viewing areas! Insects, amphibians, birds & mammals await your discovery! Explore different environments, including tundra, desert & marine life & gaining knowledge of animals from around the world.Coarse #: 1028759Date: Saturday, August 15time: 8:30am - 2:00pmCost: $28

Mystery thriftMystery Thrift: Shop till you drop! We will be visiting local garage sales and a thrift store. Bring money for your purchases and lunch. This trip will be getting on and off the bus many times.Coarse #: 1028766Date: Saturday, August 22time: 9:00am - 2:00pmCost: $28

Mt Hood Railroad train RobberyEnjoy the train while you feel the rocking of the cars, hear the whistle blow, and see the views out of the window. Share memories & songs with old & new friends as lights twinkle all around you. Experience a train robbery 1st hand like the old days. Bring a sack lunch and $40 to cover the cost of the train ride and ice cream on the way home.Coarse #: 1028770Date: Saturday, August 29thtime: 8:45am - 5:45pmCost: $45

THURSDAY&SATURDAYADVENTURESAGE:18&up

Join us for an

enjoyable trip &

comfortable ride.

Page 11: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 11

Portland Parks & Recreation

Cosmic GolfMini golf is one of America’s past times. It has been around for nearly a century and continues to be a family friendly attraction that all ages can enjoy. Enjoy unlimited black light Cosmic Golf and make the game playing experience memorable. Bring $20 for golf and lunch.Coarse #: 1028772Date: Saturday, September 5thtime: 9:30am - 1:30pmCost: $25

Camp 18The stunning camp and its eye-catching array of logging-related historic artifacts and artwork are hard to miss as you travel the Sunset Highway (26). Enjoy a good meal, browse the displays and learn more about our northwest logging heritage. Bring $20 for lunch and extra for the gift shop.Coarse #: 1028775Date: Saturday, September 12time: 9:30am - 3:30pmCost: $32

WAAAMThe WAAAM Air & Auto Museum has one of the largest collections of still-flying antique aeroplanes and still-driving antique automobiles in the country. The items on display at this museum are not only full of history, they’re full of LIFE! Bring $30 for admission and lunch in Hood River.Coarse #: 1028779Date: Saturday, September 19time: 9:00am - 3:00pmCost: $35

*Fused Glass MakingTry your hand and be creative designing your own fused glass. Choose your colors of glass and lay out a pattern you like. Bring $40 to cover the cost for your glass piece and lunch. *This is a non accessible trip Coarse #: 1028782Date: Saturday, September 26time: 9:15am - 2:45pmCost: $30

THURSDAY&SATURDAYADVENTURESAGE:18&up

Page 12: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

12 Adaptive and Inclusive Recreation 503.823.4333

Page 13: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 13

Page 14: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

14 Adaptive and Inclusive Recreation 503.823.4333

Page 15: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 15

REGISTRATIONReceipt of full payment is required for registration, unless otherwise arranged. Please call if you receive a returned check or declined bank card notice, either of which void registration.

RESIDENT/NON-RESIDENTA resident is:

•anyonewhooccupiesapermanentresidenceinsidethecity limits of Portland. At the discretion of a Community Center Director, proof of home address may be required. Acceptable address verification may include a 1) drivers license, 2) Oregon ID card, 3) property tax statement, 4) utility bill or lease agreement with current home address.

•anychildlivingwithintheschoolboundariesoftheReynolds and Centennial School Districts who is attending a SUN Community School. Through a partnership between the City and County, a child attending a SUN Community School is eligible to register for programs at any SUN Community School location without paying a non-resident surcharge.

Anyone else is considered a non-resident (NR) and will be assessed a 40% surcharge. NR surcharges do not apply to drop-in activities.

CLASSENROLLMENTOur classes must meet minimum and maximum enrollment standards. Classes may fill quickly or be canceled due to low enrollment.

WITHDRAWAL&REFUNDSPlease notify us at least five (5) business days (Monday-Friday), unless otherwise specified, before the start of your program so that we can refund or credit your account for the registration fee. Pre-paid materials and admission tickets cannot be refunded. Participants needing to withdraw after the program has begun are offered a prorated credit or refund based upon when the request is made.

SCHOLARSHIPSCity of Portland residents, regardless of age, who require financial assistance may apply for partial scholarships. Contact individual centers for information.

SPECIALNEEDSWithin the American with Disability Act (ADA), a person with a disability or special need who desires assistance with registration and/or participation in general PP&R programs can contact Inclusion Services at 503-823-4333. If you request assistance through Inclusion Services, a minimum of 10 business days (Monday-Friday) advance notice is required.

If you need a sign language interpreter or FM loop amplifier, please contact 5503-823-4333, at least five business days in advance of the activity or class. Information about programs and services is available online for those needing a voice synthesis; visit our website at www.PortlandParks.org. For additional ADA information, call 503-823-4333.

NOTICEOFNON-DISCRIMINATIONPP&R programs and services reflect the cultural diversity of our community. We do not discriminate on the basis of religion, race, color, gender, national origin, sexual orientation, age or ability.

CUSTOMERSATISFACTIONYour satisfaction is our goal! Portland Parks & Recreation strives for 100% customer satisfaction. If you are not satisfied with a recreation program or service, please let us know.

INFORMATIONHOTLINEFor information on other PP&R services & programs, call the Parks Information Hotline at 503-823-PLAY (7529), Mon-Fri, 8:30am-5pm.

INCLEMENTWEATHERIf the City of Portland public school districts (Portland Public, Parkrose, David Douglas, Reynolds, and Centennial) are closed because of weather conditions, PP&R classes and youth basketball in those school districts are cancelled. However, some sites may be open for drop-in activities. Call the specific PP&R facility for information and opening/closing times. If inclement weather is forecast on weekends or holidays, call the PP&R facility or program for operating hours and activity cancellations.

PHOTOPOLICYPortland Parks & Recreation (PP&R) reserves the right, and may give permission to the media, to photograph classes, programs, and participants at any of our facilities and properties or any sponsored

activity. Please be aware that these photos are for promotional purposes and may be used in future publications and media communications in any format.

If you do not wish to be photographed, please inform staff and we will make reasonable efforts to honor your request. If you see staff taking pictures, and you do not wish to be photographed, please let us know.

If you see a photo of yourself or a family member that causes you concern, please notify us. As a courtesy, we will make every reasonable effort to dispose of the image, and will not use it in future publications. However, we will not be able to retrieve, destroy or discontinue existing printed publications in which the photograph may have been included.

Page 16: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

16 Adaptive and Inclusive Recreation 503.823.4333

Reg

isterN

ow–One

of5

EasyWays

Your Satisfaction is Our Goal. Portland Parks & Recreation strives for 100% customer satisfaction.

More information on:Accommodations, non-resident fees, withdrawals, and policy information listed on previous page

Registration is a breeze! Choose 1 of 5 easy ways to register

Online at www.POrtlandParks.org Click on the Register now tab to search and register for classes in real-time, any time. New & improved functions include searching by age, date, location, activity, and time. As this is a new system, we have included “how to” information on our web site.

PhOne – Call our Customer Service Center at 503-823-2525, Monday-Friday, 8:30am-5pm.

Visa or Mastercard are accepted by phone. You are welcome to call any of our community centers to register over the phone as well.

Mail – Mail in your completed registration form (next page) to: PP&R Customer Service Center, 1120 SW Fifth Ave, Suite 1302, Portland, OR, 97204. Include full payment using your Visa, Mastercard or check payable to the City of Portland.

Fax – Fax to 503-823-2515. Complete the registration form (next page) and fax it to us with full payment using your Visa or Mastercard. Fax is accepted 24 hours a day, seven days a week but is processed during regular business hours.

in PersOn – Any PP&R facility is able to process your registration, including the Customer Service Center, which is located on the first floor of the Portland Building at 1120 SW Fifth Ave. See the map of our facilities within this catalog.

Adaptive and Inclusive means ever yone plays! Call 50 3 - 823-2223 V/TTY

Page 17: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Register On-Line at www.PortlandParks.org 17

RegistrationForm

CHECKONE: New Customer Taken class with PP&R before My account information has changed

Main Contact Name _______________________________________________________________________ Birthdate ___________________________ M_____ F_____

CIRCLEONE: Africanimmigrant AmericanIndian/AlaskaNative Black/AfricanAmerican Hispanic/Latino NativeHawaiian/PacificIslander White Slavic/Eastern European Immigrant Asian Multi-Racial Other

Home Address ________________________________________________________________________ City/St/Zip _______________________________________________

Home Phone (_________)________________________________________________ Work Phone (_________)_________________________________________________ Cell Phone (_________)_____________________________________________ Email Address _______________________________________________________________

Emergency Contact Name & Phone Number ___________________________________________________________________________________________________

Portland Parks & Recreation welcomes individuals with disabilities and special needs into programs. Please describe any accommodations needed for successful inclusion: _____________________________________________________________________________________________

CHECK Check number_____________________ (make check payable to the City of Portland)

CREDITCARD Information

Account # ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ Expires ____________________________________

Cardholder’s Name_____________________________________________________ Signature______________________________________________________________

PAYMENTINFORMATION

Please print

VISA

MasterCard

Name(last,first) Birthdate M/F Class Title Course # Class Location Start Date Cost

PARTICIPANTINFORMATION

TOTALnOn-residents: Please be sure to enter the non-resident (NR) class fee in the Cost column. If an NR fee is not listed in the catalog, please add a 40% surcharge to each class fee.

Portland Parks & Recreation Registration Form

Page 18: Adaptive and Inclusive Recreation (AIR) Summer activities 2015

Adaptive and Inclusive Recreation426 NE 12th Ave.Portland, OR 97232