Summer Inclusion Deadline - May 31st
If your child receives special education services in school or requires any accommodations in programs, they may qualify for free support. Our therapeutic recreation specialist will work with your family to ensure the appropriate accommodations are being made, and our qualified support staff will work with your child as needed in the various programs that he/she may attend in order to provide your child with a rewarding and fun experience.
Our therapeutic recreation specialist, support staff and program directors will work as a team to modify activities and/or equipment, provide emotional and behavioral support and facilitate social interaction so that all children can participate to their fullest potential.
Burlington Parks and Recreation utilizes a group inclusion model and 1:1 support is granted only on an as-needed basis, pending assessment by the therapeutic recreation specialist. Support staff as well as a sensory friendly indoor space will be available for quiet breaks at Club Simonds.
In order to accommodate with a sufficient number of staff members, the deadline to complete this form for summer program support is May 31. If this form is not completed by May 31, additional support services cannot be guaranteed. Thank you for your cooperation and understanding.
Please select each program your participant is registered for that you are requesting inclusion support in for the corresponding week.
NOTE: Selecting a program here does NOT count as registration for that program. Program registration must be completed separately at www.burlingtonrecreation.org this form is ONLY for requesting inclusion support services.
Pre-Summer: June 24 - 28
Week A: July 1 - 3
Week B: July 8 -12
Week C: July 15 - 19
Week D: July 22 - 26
Week E: July 29 - Aug. 2
Week F: Aug. 5 - 9
Week G: Aug. 12 - 16
Week H: Aug. 19 - 23
Please list any additional programs here.
Helpful tips before you get started!
Examples of goals: building friendships with peers, trying new leisure activities, staying active
Please list TWO additional emergency contacts Burlington Parks and Recreation can reach out to in the event of an emergency.
The parent/guardian listed above will remain the primary contact and will be contacted first.
*Medications: Please know that we do not have a nurse on staff at Burlington Parks & Recreation (BPRD) programs, and therefore we are not able to hold or administer medications to participants. We can remind participants to take their medications as needed with signed notes from a parent or guardian. Meds must be kept in a safe and appropriate location out of reach of other participants.
Please list things the participant really loves here! Be as specific as possible with these preferred topics/activities as this will help our staff connect with participants quicker and help them foster friendships between them and other participants.
Examples: Peppa Pig, Disney music, doing arts and crafts, playing basketball, etc.
Please describe in detail what it looks like when the participant gets upset. Include any triggers or signs to look out for that they may be becoming upset. This helps our staff to know what to look for and what to expect when your child does become upset.
Examples: will yell, starts to cry, will walk away from the group, starts to get extra silly.
Please describe how to best support the participant. List any tips you utilize at home or at school. Specifically describe what you do when your child does become upset.
Examples: do they need space for a few minutes? Do they do best with a different choice Schedules? Timers?
Please complete this section with the participant!
Staff will use this photo to identify the participant on the first day of program. There are many participants getting dropped off at once so a clear photo is very helpful!
Thank you for completing the summer 2024 inclusion intake packet! The next step is to schedule your intake phone call.
This phone call and the packet will be used to create an individualized inclusion plan for your family member. This is the plan inclusion staff will follow to provide support to your family member!
Signature of parent/guardian of participant
This field is not part of the form submission.
* indicates a required field