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 and email it to your Program Director or Executive Director. A YMCA 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.
Date

MonthDayYear
Date
YMCA Branch
C.W. Avery Family YMCA Kid Zone Sites
Galowich Family YMCA Kid Zone Sites
Galowich Family YMCA Teen REACH Sites
Morris Community YMCA Kid Zone Sites
YMCA Camp Location/School Site
Please specify the program/service/activity for which you seek accommodation (e.g. Before School Care, After School Care, Day Camp, Day Off School, etc.) and why the accommodation is needed to participate/attend (please be as specific as possible)
Contact Information for the person making the accommodation request:
Name*
Email*
example@example.com
Daytime Phone*
Evening Phone*
Date this form is completed

MonthDayYear
Date
Please check one

Current Y MemberCurrent Y ParticipantPotential Y Member or Participant
Thank you. Your request will be reviewed and you will hear from Y staff within 2 business days from date received to YMCA staff (not date listed above). Again, thank you.
Program Director/Executive Director Response/Action
Should be Empty: