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Western DuPage Special Recreation Association

2010
Winter/Spring
Brochure

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REGISTER ONLINE NOW

click here to view
the Fall 09 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
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?
     

 

 

There's No Place
Like WDSRA

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WDSRA Foundation's
Annual Charity Auction
Thank You for Your Support

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