Inclusion Request Form
Please complete this form to request inclusion support in any Belmont or Watertown Recreation Program. Eva Burbidge, CTRS, will reach out with next steps after reviewing the form.
Participant Name
*
First Name
Last Name
Participant Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian email
*
example@example.com
Parent/Guardian phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of program
*
Is this a Belmont or Watertown Recreation Program?
*
Watertown Recreation Program
Belmont Recreation Program
Please briefly describe desired supports:
*
I understand that requesting inclusion support is not the same as registering for a program. Please register for the desired program BEFORE requesting inclusion support. I understand that inclusion support requests must be submitted at least 10 business days prior to the program start date to allow time for the intake process and planning and implementing of appropriate supports. I understand that the need for inclusion supports, including additional staffing, is determined through an intake assessment by the Recreation Therapist. Group support and 1:1 support in not guaranteed and is provided based on the participant's assessed needs, program requirements, and staff availability.
*
Submit
Should be Empty: