ACCOMMODATION REQUEST FORM

ACCOMMODATION REQUEST FORM

Greater Joliet Area YMCA
The Greater Joliet Area YMCA will make every attempt to make reasonable accommodations for members and program participants requesting special assistance. If you have an accommodation request, please complete the Accommodation Request Form below. A Y staff team member will be in contact with you within 2 business days to discuss the request.

In order to reasonably access and benefit from the Greater Joliet Area YMCA’s programs, services and activities, please complete the information below to request an accommodation, including requesting alternative formats/ communications and modifications of policies and procedures.

*The Americans with Disabilities Act (ADA) does not require the YMCA to take any action that would fundamentally alter the nature of its programs or services or impose an undue financial hardship.
Today's Date*
YMCA Location
YMCA Location*
Please specify the program/service/activity for which you seek accommodation (e.g. Before School Care, Swim Lessons, Personal Training, etc.) and why the accommodation is needed to participate/attend (please be as specific as possible). *
Do you have a documentation from a physician?*

YesNo
Please upload accompanying physician documentation here.*

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Contact Information for the person making the accommodations request:
Name:*
Email:*
example@example.com
Daytime Phone:*
Evening Phone:
Please check one:*

Current Y MemberCurrent Y ParticipantPotential Y Member or Participant
Date this form is completed:*
Should be Empty: