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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