Recreation Inclusion Form

Recreation Inclusion Form

City of Tempe Community Services Programs
Please complete and submit the inclusion form to the City of Tempe prior to the start of the class, program or activity the accommodation request pertains to.

All sections need to be filled out by the participant or person(s) requesting.
Contact Information
Name of participant:

First NameLast Name
Date of birth (MM/DD/YYYY):
Name of parent/legal guardian:
Tempe resident?
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email address:
example@example.com
Primary phone number:
Please enter a valid phone number.Format: (000) 000-0000.
Secondary phone number:
Please enter a valid phone number.Format: (000) 000-0000.
Program Information
Program, class or activity name:
Program, class or activity code:
Location:
Dates of program, session or season:
Has the registrant participated in City of Tempe programs before?
Accommodation Information
What accommodations are you requesting?
Please explain what other accommodation you are requesting:
Please share details that you feel are important for us to know when reviewing this request.
Should be Empty:

Contact Information