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The City of Portland, Oregon

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Portland Parks & Recreation

Healthy Parks, Healthy Portland

Phone: 503-823-7529

1120 SW Fifth Avenue, Portland, OR 97204

More Contact Info

Please complete this form to request information about Portland Parks & Recreation inclusion services. Upon receipt of this form, you will be contacted by our staff to discuss your request and determine the next steps.

* Required Field 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?
Has the registrant ever used Inclusion Services before? Yes No
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.