ADA REASONABLE ACCOMMODATION REQUEST FORM

FOR YOUTH DEVELOPMENT FOR HEALTHY LIVING FOR SOCIAL RESPONSIBILITY

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 attach your doctor's note describing the disability for which you are requesting accommodation.

*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. Please note that if your request is regarding the use of face masks, the YMCA is only able to grant accommodations in such a way that the health and safety of others within our facilities and programs are not affected.

Date *

Date

Name *

Email *

example@example.com

Phone Number *

Please enter a valid phone number.

Please Choose One: *

Current Y Member Current Y Participant Potential Y Member or Participant

Home branch *

Please describe the nature, extent & duration of your requested accommodation: *

Specify the program, service or activity for which you seek accommodation: *If requesting for a childcare program, please specify the location. *

Describe the accommodations you believe are needed to enable you to use our facility and or program, including requesting alternative formats, communications, and modifications of policies and procedures: *

Please upload your doctor's note *

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Thank you. Your request will be reviewed and you will hear from the Y staff within two business days of submitting this form.