Rec & Roll Adult Day Program Interest Form

PLEASE NOTE

At this time, all sites are full except for select days at our Wheaton (1:6) and Winfield (1:6 sites). If you are interested in joining a site that is already full (Naperville, Carol Stream, Glen Ellyn, Fountain View, or Fort Hill), you will be placed on the waitlist and will not be contacted to do an intake until an opening is available. WDSRA in-district residents will receive priority on the waitlist before out-of-district.

Rec & Roll Adult Day Program Interest Form

New participants are welcome to join WDSRA’s adult day program, Rec & Roll at any point throughout the year. WDSRA offers several locations within our day program to meet the needs of our communities and families. Each location, and ratio, has specific participation requirements that must be met to be considered for the program. The Day Program Assistant Managers will assess and determine which program best meets the needs of each individual interested in the day program. New participants may be placed on a waitlist until a spot becomes available and are subject to a assessment period upon entry. Please complete the form below to help our staff learn more about your participant and the day program you are interested in. Our Day Program Assistant Managers will get back to you within 2 weeks of your inquiry.

Contact Information

Interested Participant's Name(Required)

First Last

Age(Required)

Must be 22 to participate

Disability(s)(Required)

Primary Guardian's Name

Guardian's Relationship to the Participant

Address(Required)

Street Address Address Line 2 City ZIP Code

Your Email Address(Required)

Your Phone Number(Required)

Preferred Method of Contact(Required)

Primary Language Spoken at Home

How Did You Hear About Rec & Roll?

Thank you for your interest! A Day Program Assistant Manger will contact you within 14 business days of the form being submitted.

NOTE: Due to an increased volume of interest, the intake process is taking longer than typical.

Rec & Roll Interest Form

PLEASE NOTE