Skip to Main Content View Text-Only

Parks & Recreation

Healthy Parks, Healthy Portland

Phone: 503-823-PLAY (7529)

Fax: 503-823-6007

1120 SW Fifth Ave., Suite 1302, Portland, OR 97204

Accommodation Request Form
Please submit the following information to request accommodation. The individual must be registered for the class/activity before making an accommodation request. We ask that the request be made ten (10) business days (Monday- Friday) before the start of the activity. (Fields marked with an asterisk * must be filled in.)
Registrant's Name*
Contact Person*
Phone Number*
Cell Phone Number
Email*
Course Name*
Course Number*
Has the registrant ever used Inclusion Services before?
What type of accommodation is needed to be successful in this activity?
Are there any safety/behavioral concerns for the registrant in this activity?
A staff person from Inclusion Services will contact you within three (3) business days to discuss this information and any additional accommodations, support, and services that may be necessary.
* Required Field

Heartbleed Security Notice

A serious security vulnerability known as "Heartbleed" was recently discovered in OpenSSL, a popular software library commonly used by many websites on the internet to encrypt communication between a user's computer and a web server.

PortlandOregon.gov is NOT affected by this vulnerability as it does not use the OpenSSL software library. Please rest assured we are dedicated to protecting your security on this website.