OUR MISSION To provide quality recreational programs and services for Champaign-Urbana residents with disabilities.
OUR VISION To create a diverse, dynamic, and inclusive community that provides opportunities for people of all abilities.
INVITE US TO SPEAK CUSR staff members are knowledgeable in many disability-related issues and topics. Let us talk to your group about the Americans with Disabilities Act, integration, and the future of special recreation. An overview of CUSR’s mission, trends in recreation, and many other topics are available to you with a simple phone call. Call the CUSR office at 217-239-1152 to schedule.
CUSR CHAMPAIGN-URBANA SPECIAL RECREATION
CUSR Hays Recreation Center 1311 W. Church St. Champaign, IL 61821
Phone: 217-239-1152 Fax: 217-373-7951 | 711 Relay E-Mail: [email protected] Website: cuspecialrecreation.com
Office Hours: Mon-Fri, 8am-5pm Office Closed: Jan 1, Jan 21, May 27
Inclusive Programs Through CUSR CUSR and its member park districts believe that all individuals should be provided with leisure opportunities that allow for performance at their highest level of ability. We understand that not every person who has a special need desires CUSR programming. In cooperation with the Champaign Park District and the Urbana Park District, CUSR staff will be happy to assist and advise any resident who is interested in participating in local park district programs. CUSR will provide the type of support deemed necessary for successful participation. Support may include training with the park district staff members, consultation with the individual and the individual’s family members, and the assistance of a support staff member. CUSR provides all inclusion services at no cost to the individual. For more information, please contact CUSR.
Program History CUSR is an intergovernmental cooperative made up of the Champaign and Urbana Park Districts, founded in 1985. CUSR provides year-round leisure and recreation opportunities for children and adults with disabilities. Our mission is to enhance participants’ abilities in enjoyable recreational, leisure, and social settings. CUSR participants explore new areas of interest, make new acquaintances, and learn lifetime leisure skills. Our services include inclusive and cooperative programs, special events, after school programs, overnights, trips, Special Olympics, summer day camps, and much more.
Americans with Disabilities Act (ADA) CUSR complies with the Americans with Disabilities Act (ADA) which prohibits discrimination on the basis of a disability. CUSR will make reasonable accommodations in recreation programs to enable participation by an individual with a disability who meets essential eligibility requirements. The recreation programs offered by CUSR will be available in the most integrated setting appropriate for each individual. If you have any questions regarding the ADA, or believe you have been unfairly discriminated against by CUSR, please contact CUSR at 217-239-1152.
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what’s inside
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Preschool ............................................ 5Youth & Teen Programs ..................... 6Adult Programs ................................... 8 Adult Trips ......................................... 13 Special Events .................................. 14Special Olympics .............................. 21Athletics ............................................ 22 Registration Form ............................. 25Waiver and Release .......................... 26Special Olympic Application ........... 27CUSR Information ............................. 29Winter | Spring Calendars ................ 32
*STAFF CELL PHONE POLICYCUSR cell phone numbers are to be used for emergencies only. Per our policy, these phones will only be on an hour before a program until the end of the program. If you need to reach a coordinator between the hours of 8:00am and 5:00pm, Monday thru Friday, please call the Hays Recreation Center.
CUSR WINTER | SPRING
GUIDE 2019
CHAMPAIGN CUSR Office Hays Recreation Center Eisner Park / 1311 W. Church St. / 217-239-1152Jupiter’s at the Crossing 2511 Village Green Pl. / 217-366-8300 Leaders for Life Martial Arts2413 Village Green Pl. Leonhard Recreation Center2307 Sangamon Dr. / 217-398-2550 Prairie Farm 2202 W Kirby Ave.The Pottery Place 1808 Round Barn Rd. Stephens Family YMCA 707 N Country Fair Dr.Western Bowl 917 Francis Dr. / 217-359-1678
URBANA Urbana Indoor Aquatic Center 102 E Michigan University of Illinois Armory 505 East Armory Ave. Phillips Recreation Center 505 W. Stoughton PESOTUM Healing Horse Stables 378 County Road 700 E
PROGRAM LOCATIONS
CUSR STAFF
CUSR CHAMPAIGN-URBANA SPECIAL RECREATION
Kyle Shartzer | CELL: 217.369.8758*ATHLETICS & VOLUNTEER COORDINATOR
Christina Mott | CELL: 423.616.1821* YOUTH & TEEN COORDINATOR
Grace Rolnicki | CELL: 217.369.9185*CTRS – INCLUSION COORDINATOR
Jameel Jones DIRECTOR OF RECREATION
Rachel Voss RECEPTIONIST
PROGRAM LOCATIONS TABLE OF CONTENTS
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REGISTRATION A CUSR registration form must be used. You may register for CUSR programs at these locations: Hays Recreation Center 1311 West Church Street, Champaign Douglass Community Center 512 E. Grove Street, Champaign Leonhard Recreation Center 2307 Sangamon Drive, Champaign Springer Cultural Center 301 N. Randolph Street, Champaign
Or register online at cuspecialrecreation.com
Full payment must be received upon registration unless specific arrangements have been made with the CUSR office. Registrations will not be processed if a fee balance remains from a previous season. Registrations are accepted in person at the locations listed to the left, through mail, online, and by fax (217-373-7951). When faxing, please include credit card information so we may process the registration. Coordinators and program leaders MAY NOT receive payment or registration forms at programs. CUSR does not prorate for late registration. Exceptions may be made for people who are new to the community.
NON-RESIDENT POLICY
PAYMENT
To ensure more individuals have access to the CUSR programs of their choice, there is a new policy for all those non-residents whom do not pay taxes into Champaign or Urbana Park District. Non-residents now have the option to pay $50 for a year’s privilege to register at resident rate. This charge is yearly starting from the time initially paid. This fee does not include access to scholarships, those are reserved for tax-paying residents of the Champaign and Urbana Park District.
CTRS-Certified Therapeutic Recreation SpecialistThe CUSR full-time program staff are all Certified Therapeutic Recreation Specialists. This certification demonstrates that each of these individuals, through education, experience, and passing a knowledge-based examination, has met the minimum requirements for practice in therapeutic recreation. The national exam for Therapeutic Recreation Specialists is based on knowledge from the National Job Analysis Study for Therapeutic Recreation which defines the important skills and knowledge necessary for minimum competency in the therapeutic recreation practice.
CUSR employs experienced professionals who understand the level of skill, both physical and mental, needed to participate fully and safely in the programs they plan.
CUSR Transportation PolicyOur door–to–door routes need to have a minimum of two registrants to run. If a route is canceled, a phone call will be made to the participant and their caregiver, and a full refund will be issued to the participant’s account.
Therefore, CUSR reserves the right to determine if a program is suitable for an individual. Staff may serve as a resource to suggest alternate programming.
At times, participants may require assistance taking medication during programs. If the participant is unable to self-medicate or take the medication prior to or after the program, CUSR requires additional paperwork, and pre-packaged medication must be delivered to our office prior to the program.
All residents of Champaign-Urbana are important to us! If you are new to the area, Champaign-Urbana Special Recreation invites you to come discover the programs and events for you and your family. Throughout the year, we provide a large variety of educational, social, recreational, and sports activities for all ages and abilities. To learn more about what we have to offer, call 217-239-1152 and we will be happy to explain any program or service. As a potential program participant, we would like to meet with you and your family!
Medication
HELLO
WINTERWELCOME
SPRING
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Sensory Snacks Ages 3-5With a pinch of this and a dash of that, come whip up a tasty treat while exploring all of our senses in this pre-school friendly cooking class. Participants will create and enjoy a delicious snack while having fun with peers. Parents/guardians must be present.
GOALS: Learn new skills, increase motor skills, functioning and development, and socialization. Date Program ID Mar 13–May 22 419501-01
Day: Wednesday Time: 9-10:15am Location: Hays Recreation Center Fee (R/NR): $16/$24 for all 10 sessions Min/Max: 4/12 Deadline: 1 week prior to program No Door-to-Door Transportation
PRESCHOOLNEW!
In partnership with Community Choices and CUSR, the Urbana Indoor Aquatic Center is hosting a community friendly event open to the general public. This event will be run by people with intellectual and developmental disabilities as well as staff from UIAC. Expect an afternoon full of interactive pool games, water sports, and much more! There will be prizes and ways for the non-swimmers to get involved!
Fee: Ages 0-4: Free; Ages 4+: $6 No Door-to-Door Transportation
Urbana Indoor Aquatic Center12:30-2:30pm
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YOUTH & TEENAfter School Program Ages 5-22 Fill your afternoon with games, sports, arts and crafts, cooking, field trips, and hanging out with friends! We will offer an amazing, as well as safe, atmosphere where we will laugh, play, grow, and learn new skills.
GOALS: Improve verbal and social skills, build new friendships, gain self-confidence and independence, and expand knowledge of leisure activities.
Month Time Program ID January 2:30-5:30pm 419502-01 February 2:30-5:30pm 419502-02 March 2:30-5:30pm 419502-03 April 2:30-5:30pm 419502-04 May 2:30-5:30pm 419502-05
Date: August 16, 2018–May 28, 2019 Day: Monday–Friday Location: Hays Recreation Center Fee (R/NR): $201/$301.50 NOTE: March Fee (R/NR): $151/$226.50 Min/Max: 8/15 Deadline: 1 week prior to month starting
Spring Break Camp Ages 5-22Are you looking for something fun and exciting to do over Spring Break? This program has just what you need! We will be filling our days with crafts, cooking, field trips, group games, and so much more! Please bring a sack lunch each day. Please note that CUSR is a nut free camp.
GOALS: Improve verbal and social skills, build new friendships, gain self-confidence, independence, and expand knowledge of leisure activities. Month Time Program ID March 18–22 8am-5pm 419503-01
Day: Monday–Friday Location: TBD Fee (R/NR): $130/$195 Min/Max: 8/15 Deadline: March 11
SCHOLARSHIPS AVAILABLE FOR IN-DISTRICT RESIDENTS
CUSR provides a scholarship policy to reduce certain fees and charges. Scholarship applications are not guaranteed and are based on available funds, program registration, or choice of program location. Early applications are given priority. Please apply 3-4 weeks before the program start
date. Applications are available at the CUSR office and can be mailed
upon request. Need is the primary criteria upon which scholarship applicants are considered.
NUT FREE
CUSR IS NUT FREE
"opportunities for youth
with the community."to socialize and engage
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Martial Arts Ages 16-35Experience the art of Taekwondo and gain overall exposure to the martial arts. CUSR has partnered with Tina and Jeff Newberry of Leader’s for Life/Newberry’s Martial Arts in order to provide a comprehensive curriculum. This class will be taught by instructors who have years of experience teaching martial arts to individuals with and without disabilities. This program will offer a balanced physical and mental workout.
NOTE: A uniform is required to participate, but not included in program fee. The cost for a uniform is $45 payable to Central Illinois Taekwondo. Uniform sizes will be determined at the first class. Promotion tests are part of the curriculum (at an additional cost of $50). Other costs will occur and you will receive a letter upon registration.
“I am passionate about providing an atmosphere where children and adults will never be made fun of or criticized…a place where everyone will be made to feel like champions.” –Master Tina NewberryGOALS: Increase concentration and balance and improve coordination, gross motor skills, endurance, and flexibility. The class will also focus on self-confidence and self-defense. Date Time Program ID Jan 8–Apr 23 4-4:45pm 419504-01 Day: Tuesday Location: Leaders for Life Martial Arts Fee (R/NR): $171/$256.50 Min/Max: 4/18 Deadline: January 2 No Door-to-Door Transportation
Sensory Egg Hunt Ages 2-10The hunt is on! CUSR invites you to celebrate spring and enjoy some family fun at Prairie Farm! Hunters should bring a basket and be prepared to search high and low for colorful eggs. Be prepared to explore your senses while searching for special eggs with lights, sounds, and textures. After the hunt, treats and social time will be enjoyed by all.
GOALS: Enhance socialization with peers and increase independence and decision-making skills. Date Time Program ID April 6 1pm 419506-01 Day: Saturday Location: Prairie Farm Fee (R/NR): Free! Min/Max: 6/40 Deadline: March 29 No Door-to-Door Transportation
SPECIAL EVENTYOUTH & TEEN
Friday Night Fun Ages 5-22Parents, enjoy a night on the town while the kids hang out with friends at CUSR! Participants and staff will cook up a delicious dinner, play games, watch movies, and make memories with friends! Dinner, snacks, and fun will be provided by CUSR.
GOALS: Improve verbal and social skills, build new friendships, gain self-confidence and independence. Date Time Program ID February 15 5:30-8:30pm 419505-01 April 5 5:30-8:30pm 419505-02 Day: Friday Location: Hays Recreation Center Fee (R/NR): $25/$37.50 Min/Max: 4/12 Deadline: 1 week prior to program No Door-to-Door Transportation
NEW!
Join our email list! Please provide email address on the registration form.
Stay connected with CUSR online: Facebook.com/CUSpecialRec
FREE!
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ADULTSMONDAYCanvas Creations Ages 14+Explore your inner artist and paint a masterpiece! CUSR will provide art canvases, paints, brushes, and a monthly theme. Whether you create a canvas painting for yourself or someone else, it will be a fun time!
GOALS: Enhance motor skills, artistic skills, and increase socialization with peers.
Date Program ID Transportation ID Jan 14,21,28 419507-01 419507-T1 Mar 11,19,25 419507-02 419507-T2
Day: Monday Time: 6-7pm Location: Hays Recreation Center Fee (R/NR): $42/$63 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Jumpin’ @ Jupiter’s Ages 18+Meet us at Jupiter's at the Crossing for a night with your friends! Play pool, enjoy arcade games, and win prizes!
GOALS: Increase money management skills and enhance social skills with peers and community members.
Date Program ID Transportation ID January 28 419508-01 419508-T1 February 25 419508-02 419508-T2 March 25 419508-03 419508-T3 April 29 419508-04 419508-T4 Day: Monday Time: 7-9pm Location: Meet at Jupiter’s at the Crossing Fee (R/NR): $20/$30 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
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ADULTSTUESDAY
ADULTSWEDNESDAY
Blackout B-I-N-G-O Ages 14+Come one, come all for a night of Bingo! You will enjoy hanging out and socializing with your friends, and may even win some prizes.
GOALS: Enhance socialization with peers, turn-taking skills.
Date Program ID Transportation ID February 13 419509-01 419509-T1 April 10 419509-02 419509-T2
Day: Wednesday Time: 6-7pm Location: Hays Recreation Center Fee (R/NR): $18/$27 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Dancing in Decatur Ages 21+CUSR will be venturing out to enjoy an evening of dancing and snacks at the Knights of Columbus in Decatur, Illinois. Join us as we dance the night away and meet new friends. Admission is included; just bring your dancing shoes!
GOALS: Enhance socialization with peers, meet new people.
Date Program ID Transportation ID January 2 419511-01 419511-T1 February 6 419511-02 419511-T2 March 6 419511-03 419511-T3 April 3 419511-04 419511-T4
Day: Wednesday Time: 5:15-9pm Location: Meet at the Hays Recreation Center Fee (R/NR): $38/$56 Min/Max: 6/24 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Theatre 101 Ages 22+Whether you're a seasoned veteran on stage or just starting out, this course is perfect for you! Actors will meet twice a week to learn the basics, write their scripts, rehearse their roles, and much more! At the end of this 8-week course, all actors will perform in a cabaret-style show.
GOALS: Enhance socialization with peers and increase knowledge of threatre and acting, enhancing theatrical skills.
Date Program ID Transportation ID Jan 15–Mar 9 419510-01 419510-T1
Day: Tuesday & Saturday Time: Tuesday: 5:30-7:00pm Saturday: 11am-12:30pm Location: Hays Recreation Center Fee (R/NR): $125/$187.50 Min/Max: 6/24 Deadline: 1 week prior to program Door-to-Door Transportation: $60
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ADULTSTHURSDAYDiner’s Club Ages 18+Join us as we go out to different restaurants for dinner. At Diner’s Club you will be able to socialize with your friends and enjoy a great meal, included in the fee.
GOALS: Enhance socialization with peers, increase money management skills, and dining etiquette.
Date Restaurant Program ID Jan 17 Scotty's Brewhouse 419512-01 Feb 21 El Toro (Springfield Ave) 419512-02 Mar 14 Olive Garden 419512-03 Apr 18 Cracker Barrel 419512-04
Day: Thursday Time: 6-7:30pm Location: Meet at restaurant Fee (R/NR): $42/$63 Min/Max: 4/12 Deadline: 1 week prior to program Transportation ID: 419512-T1, -T2, -T3, -T4 Door-to-Door Transportation: $10
Hays Hangout Ages 18+Fill the evening with a night of cards, Wii video games, board games, and more. At Hays Hangout, the goal is to have fun and socialize with your friends! Snacks are included.
GOALS: Enhance socialization with peers and turn taking skills.
Date Program ID Transportation ID February 28 419513-01 419513-T1 April 25 419513-02 419513-T2
Day: Thursday Time: 6:30-8pm Location: Hays Recreation Center Fee (R/NR): $12/$18 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation: $10
CUSR Transportation PolicyOur door–to–door routes need to have a minimum of two registrants to run. If a route is canceled, a phone call will be made to the participant and their caregiver, and a full refund will be issued to the participant’s account.
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Movie Night Ages 16+Bring out your inner critic! Join us as we choose movies to watch at the Hays Center, or feel free to bring your own movies from home to share with us. CUSR will provide snacks for this night of fun.
GOALS: Enhance socialization with peers, increase listening and comprehension skills.
Date Program ID Transportation ID February 22 419515-01 419515-T1 April 26 419515-02 419515-T2
Day: Friday Time: 6:30-8:30pm Location: Hays Recreation Center Fee (R/NR): $16/$24 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation: $10
ADULTSFRIDAYMovie Critics Ages 16+Grab your friends and get ready to see some of this season’s biggest hits. We will be watching the newest releases each month. Program time may vary depending on show times. Participant will receive a call with exact program times the week of program date. Admission included in program fee; please bring money for snacks.
GOALS: Improve listening skills, community awareness, and socialization with peers and community members.
Date Program ID Transportation ID January 11 419516-01 419516-T1 March 1 419516-02 419516-T2
Day: Friday Time: TBD Location: Meet at Movie Theater (participants will be called and informed of the theater location the week of each session) Fee (R/NR): $35/$52.50 Min/Max: 4/10 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Karaoke & Dancing Ages 16+Attention all singers and dancers! We are busting out the karaoke machine for a night of fun and talent. Whether you choose today's hits or the classics, it's going to be a great time!
GOALS: Increase socialization skills and turn-taking skills.
Date Program ID Transportation ID January 25 419514-01 419514-T1 March 22 419514-02 419514-T2
Day: Friday Time: 6:30-8pm Location: Hays Recreation Center Fee (R/NR): $18/$27 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation: $10
"please continue doing all the wonderful things you do! our community needs cusr."
NUT FREE
CUSR IS NUT FREE
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ADULTSSATURDAYDinner & Cosmic Bowling Ages 18+Looking for ways to fill your Saturday nights? Join us for dinner and bowling! CUSR staff will pick a surprise restaurant 1-week prior to the program. After dinner you’ll head to Arrowhead Lanes for Cosmic Bowling. Fee includes your dinner and two games of bowling. *NOTE: STROBE LIGHTS MAY CAUSE SEIZURE ACTIVITY.
GOALS: Improve gross motor coordination, turn-taking skills, and socialization with peers.
Date Program ID Transportation ID February 9 419518-01 419518-T1 April 13 419518-02 419518-T2 Day: Saturday Time: 7-11:30pm Location: Meet at the Hays Recreation Center Fee (R/NR): $45/$67.50 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Therapeutic Horseback RidingAges 5-35
Dreaming of riding horses and learning how to care for them? At Healing Horse Stables you will learn riding skills through an hour-long lesson including various exercises and activities from a P.A.T.H. (Professional Association of Therapeutic Horsemanship) certified instructor. You will also have a ground lesson where you will learn how to groom and saddle a horse.
GOALS: Increase in concentration and balance, improved coordination, gross motor skills, improve overall orientation and body awareness, muscle tone, posture, flexibility, increase of knowledge about horses and riding, improved emotion well-being, and forming a connection with a non-judgmental being. Date Program ID March 23– May 4 419517-01 *No Class April 27
Day: Saturday Time: 10am-12pm Location: Healing Horse Stables, Pesotum Fee (R/NR): $191/$286.50 Min/Max: 4/8 Deadline: March 15 Transportation: Meet at the Hays Recreation Center at 9:20am and pick-up at the Hays Recreation Center at 12:30pm or meet at the stables by 9:45am and be picked up from stables at 12pm. No Door-to-Door Transportation
SCHOLARSHIPS & PAYMENT PLANS AVAILABLE
NOTE: Closed-toed gym shoes are required and no high heels. Due to safety concerns, you will not be able to participate in improper footwear. Cowboy boots are welcome! Long pants are highly recommended to protect your legs from the saddle and horse. Bring a water bottle each week! **There is a weight limit of 250 lbs.
THEATRE 101TUESDAY & SATURDAY | AGES 18+See full program description on page 9.
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ADULT TRIPOVERNIGHT: Indianapolis, INAges 21+Please join us for an action packed adventure to Indianapolis, Indiana! We will take in all that this great city has to offer! During our stay we will visit the Indianapolis City Zoo, attend an Indiana Pacer's Game, go to the famous Hard Rock Café, and have dinner and enjoy a show at the Mystery Café Dinner Theatre! Program fees include lodging, meals, and admission. Please bring extra money for souvenirs and snacks.
GOALS: Enhance socialization skills, money management, and cultural awareness. Date Program ID April 5–7 419519-01 Day: Friday-SundayTime: TBDLocation: Meet at Hays Recreation CenterFee: $340Min/Max: 6/12Deadline: 1 week prior to programNO DOOR-TO-DOOR TRANSPORTATION
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JANUARY SPECIAL EVENTS
Snow Tubing Ages 16+Join CUSR at Villa Olivia for a fun filled day on the slopes! Downhill skiing, snowboarding ,and snow tubing are right in your backyard! Located in the Chicago-land area with 100% artificial snow you can enjoy an authentic mountain powder experience. There's something for everyone at Villa Olivia. Lunch and admission are included in the program fee.
GOALS: Improve gross motor coordination and enhance socialization with peers.
Date Program ID Transportation ID January 5 419521-01 419521-T1 Day: Saturday Time: 9am-6pm Location: Meet at Hays Recreation Center Fee (R/NR): $60/$90 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Oishi Asian Cuisine Ages 16+Enjoy authentic Asian cuisine with your friends as CUSR takes you to Oishi! Socialize with your friends and enjoy a wide assortment of Japanese flavors. You won't want to miss out on this dining experience!
GOALS: Enhance dining etiquette and socialization with peers.
Date Program ID Transportation ID January 24 419523-01 419523-T1 Day: Thursday Time: 5:30-7:30pm Location: Meet at restaurant Fee (R/NR): $40/$60 Min/Max: 5/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
Cookie Decorating & Hot Chocolate Bar Ages 16+Warm up by baking fresh cookies and enjoying a hot chocolate bar. Once the cookies are done baking, we will use all sorts of sweet treats to decorate them. Give them as gifts or keep them for yourself!
GOALS: Enhance cooking skills, dining etiquette, and socialization with peers.
Date Program ID Transportation ID January 9 419522-01 419522-T1 Day: Wednesday Time: 6-7:30pm Location: Hays Recreation Center Fee (R/NR): $20/$30 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
Stay connected with CUSR online: Facebook.com/CUSpecialRec
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Chicago Bulls Basketball Ages 18+It’s basketball season and CUSR is heading to Chicago to cheer on the Chicago Bulls as they face the Cleveland Cavaliers! Grab your Bulls gear and don't forget your cheering voice too! Program fee includes admission and travel. Please bring money for lunch and souvenirs.
GOALS: Increase socialization with peers, knowledge of Basketball, positive sportsmanship, and dining etiquette.
Date Program ID Transportation ID January 27 419520-01 419520-T1
Day: Sunday Time: 11:30am-8pm Location: Meet at the Hays Recreation Center Fee (R/NR): $120/$180 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
"opportunities for people with special needs to do fun activities
in a safe environment."
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Valentine's Day Dance Ages 18+Travel to Bloomington, IL to join SOAR at their annual Valentine's Day Dance. Enjoy music by a DJ and dance the night away! We will also have a light snack.
GOALS: Enhance socialization with others and meet new people. Date Program ID Transportation ID February 8 419524-01 419524-T1 Day: Friday Time: 5:30-9:30pm Location: Meet at Hays Recreation Center Fee (R/NR): $32/$48 Min/Max: 6/22 Deadline: 1 week prior to program Door-to-Door Transportation: $10
FEBRUARY SPECIAL EVENTS
Illini Basketball Ages 16+Throw on your Illini gear and join CUSR as head to the State Farm Center to cheer on the Fighting Illini as they face the University of Nebraska's Huskies. Program fee includes admission. Please bring money for snacks and souvenirs.
GOALS: Increase socialization with peers and community members.
Date Program ID Transportation ID February 2 419527-01 419527-T1 Day: Saturday Time: 12:30-4:30pm Location: Meet at Hays Recreation Center Fee (R/NR): $58/$87 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Sweets & Treats Ages 16+Put on your chef hat and satisfy your sweet tooth! We will be following recipes and creating a variety of desserts and treats. Afterwards, delight in our creations and you can even take some home to share with friends and family!
GOALS: Enhance cooking skills, dining etiquette, and socialization with peers.
Date Program ID Transportation ID February 4 419528-01 419528-T1 Day: Monday Time: 5:30-7pm Location: Hays Recreation Center Fee (R/NR): $18/$27 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NUT FREE
CUSR IS NUT FREE
NEW!
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Valentine's Day Party Ages 16+Love is in the air! Join your friends at CUSR as we celebrate Valentine's Day. We will play games, enjoy a tasty snack, and dance.
GOALS: Increase socialization with peers and community members. Date Program ID Transportation ID February 11 419525-01 419525-T1 Day: Monday Time: 6-7:30pm Location: Hays Recreation Center Fee (R/NR): $18/$27 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
ISU Men’s Basketball Ages 16+Join CUSR as we travel to Bloomington-Normal to watch the Illinois State Redbirds take on the Braves from Bradley. Wear your ISU gear and get ready to cheer. Program fee includes admission and travel. Please bring money for snacks.
GOALS: Increase socialization skills with peers and community members and basketball knowledge. Date Program ID Transportation ID February 16 419526-01 419526-T1
Day: Saturday Time: 5:30-11pm Location: Meet at Hays Recreation Center Fee (R/NR): $55/$82.50 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Skiing at Villa Olivia Ages 16+Join us again in the Chicago-land area for a fun-filled day of skiing! Villa Olivia offers slopes for all levels of experienced skiers. Participants can race each other down the mountain in a fun-filled environment! This will be an exciting experience for everyone. Lunch and admission are included in the program fee.
GOALS: Improve gross motor communication and enhance socialization with peers.
Date Program ID Transportation ID February 17 419529-01 419529-T1 Day: Sunday Time: 8:30am-5pm Location: Meet at Hays Recreation Center Fee (R/NR): $125/$187.50 Min/Max: 6/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Indoor Pool Party Ages 16+Take a leap from the diving board and have a party! Join CUSR at the Stephens Family YMCA in Champaign for some pizza, cupcakes, and drinks as we swim into the afternoon with friends!
GOALS: Enhance socialization with peers.
Date Program ID Transportation ID February 24 419530-01 419530-T1 Day: Sunday Time: 11am-2pm Location: Stephens Family YMCA Fee (R/NR): $42/$63 Min/Max: 6/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Stay connected with CUSR online: Facebook.com/CUSpecialRec
Join our email list! Please provide email address on the registration form.
NEW!
NEW!
PLEASE VISIT cuspecialrecreation.com 18
MARCH SPECIAL EVENTS
Pottery Place Ages 18+Paint the evening away with your friends from CUSR as we visit Pottery Place. Fee includes your paint, studio time, and one piece of pottery. Just bring your creativity!
GOALS: Enhance socialization with peers and social skills. Date Program ID Transportation ID March 8 419533-01 419533-T1
Day: Friday Time: 6:30-8:30pm Location: Meet at Pottery Place Fee (R/NR): $35/$52.50 Min/Max: 6/24 Deadline: 1 week prior to program Door-to-Door Transportation: $10
St. Patty's Day Party Ages 18+Are you feeling lucky? Join CUSR as we celebrate St. Patrick's Day! We will be playing games, enjoying a tasty snack, and making a St. Patrick's Day craft.
GOALS: Enhance social skills with peers and community members. Date Program ID Transportation ID March 12 419532-01 419532-T1
Day: Tuesday Time: 6-7:30pm Location: Hays Recreation Center Fee (R/NR): $18/$27 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Bowling & Bingo Ages 16+Looking for a fun-filled Saturday night? Join us at Arrowhead Lanes for some bingo and bowling. Participants will play two games of bowling after some exciting games of Bingo!
GOALS: Improve gross motor coordination, turn-taking spills, and socialization with peers. Date Program ID Transportation ID March 23 419531-01 419531-T1
Day: Saturday Time: 2-4pm Location: Arrowhead Lanes Fee (R/NR): $30/$45 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
NUT FREE
CUSR IS NUT FREE
Dave & Buster's Ages 18+What's better than great food and arcade games? Join us for a trip to Dave & Buster's in Orland Park! Have fun trying the 200 games they have to offer and enjoy a delicious lunch. Program fee includes meal and playing card. Please bring additional money for extra games and souvenirs.
GOALS: Enhance socialization with others, develop dining etiquette and turn-taking skills, and practice money management skills.
Date Program ID Transportation ID March 27 419549-01 419549-T1
Day: Wednesday Time: 9am-4pm Location: Meet at Hays Recreation Center Fee (R/NR): $65/$97.50 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
PLEASE VISIT cuspecialrecreation.com 19
APRILSPECIAL EVENTS
Pizza & Movie Ages 16+Join your friends at the Hays Recreation Center for a night of good food and even better company! You will be making your personal pizza and enjoying a movie on the big CUSR screen. All ingredients will be provided.
GOALS: Enhance cooking skills, dining etiquette, and listening skills
Date Program ID Transportation ID April 2 419534-01 419534-T1
Day: Tuesday Time: 6-8:30pm Location: Hays Recreation Center Fee (R/NR): $25/$37.50 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Girls Night In Ages 16+Join CUSR for a fun night with the girls! Participants will enjoy dinner together and spend some quality time socializing. You can play games, get to know each other, make new friends, and make lasting memories!
GOALS: Enhance socialization with peers.
Date Program ID Transportation ID April 12 419538-01 419538-T1
Day: Friday Time: 6-8pm Location: Hays Recreation Center Fee (R/NR): $20/$30 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Sweet "Egg" Escape Ages 16+You're never too old for an egg hunt! Join CUSR as we hunt for eggs in Eisner Park, dye and decorate eggs, and enjoy a light snack at Hays Recreation Center. Please be sure to dress appropriately for the outdoor egg hunt.
GOALS: Enhance social skills with peers and community members. Date Program ID Transportation ID April 14 419536-01 419536-T1
Day: Sunday Time: 2-3:30pm Location: Hays Recreation Center Fee (R/NR): $26/$39 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Wii Bowling Ages 16+Join your friends at the Hays Recreation Center for a night of fun-filled entertainment. Participants will bowl on the popular video gaming system: the Wii!
GOALS: Enhance socialization with peers and motor skills. Date Program ID Transportation ID April 8 419535-01 419535-T1
Day: Monday Time: 6-7pm Location: Hays Recreation Center Fee (R/NR): $10/$15 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
NEW!
PLEASE VISIT cuspecialrecreation.com 20
APRIL SPECIAL EVENTS
Chicago Blackhawks vs St. Louis Blues Hockey Ages 18+Calling all hockey lovers, you're needed for one of the biggest rivalries of the Midwest. Join us as we travel to St. Louis to watch the Chicago Blackhawks take on the St. Louis Blues! Whether your team wins or loses, you're sure to have a great time. Program fees includes admissions and travel. Please bring additional money for dinner and souvenirs.
GOALS: Increase money management skills and enhance social skills with peers and community needs.
Date Program ID Transportation ID April 3 419550-01 419550-T1
Day: Wednesday Time: 4pm-12am Location: Meet at Hays Recreation Center Fee (R/NR): $120/$180 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Market Place Mall Scavenger Hunt Ages 16+Mall shopping can be a bittersweet experience; sometimes you find everything you were looking for, but other times you walk out empty-handed. CUSR wants to make sure you have the very best experience. Join our scavenger hunt at Market Place Mall and you'll walk out finding everything you were looking for without spending any money! Will you be the first to complete the challenge? Program fee includes dinner.
GOALS: Enhance social skills with peers and community members.
Date Program ID Transportation ID April 16 419537-01 419537-T1 Day: Tuesday Time: 5:30-7pm Location: Meet at Market Place Mall Food Court Fee (R/NR): $28/$42 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation: $10
Boys Night In Ages 16+Join CUSR for a fun night with the guys! Participants will enjoy dinner together and spend some quality time socializing. You can play games, get to know each other, make new friends, and make lasting memories!
GOALS: Enhance socialization with peers.
Date Program ID Transportation ID April 19 419539-01 419539-T1
Day: Friday Time: 6-8pm Location: Hays Recreation Center Fee (R/NR): $20/$30 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW! Banana Splits & Movies Ages 16+Come and enjoy a delicious banana split with friends while we watch one of our favorite movies! Participants will put together their own banana split with an assortment of toppings while socializing and enjoying a great movie!
GOALS: Meet new people and enhance socialization skills.
Date Program ID Transportation ID April 23 419541-01 419541-T1
Day: Tuesday Time: 6-8pm Location: Hays Recreation Center Fee (R/NR): $20/$30 Min/Max: 4/15 Deadline: 1 week prior to program Door-to-Door Transportation: $10
NEW!
PLEASE VISIT cuspecialrecreation.com 21
Spring Formal Ages 16+It’s that time of year again! CUSR is hosting our annual Spring Formal at the Phillips Recreation Center. This year’s theme is “Roaring 20s”. Come dressed in your best vintage 1920's outfit! Music will be provided by a local DJ!
GOALS: Meet new people and enhance socialization skills.
Date Program ID Transportation ID April 27 419540-01 419540-T1
Day: Saturday Time: 6-8pm Location: Phillips Recreation Center Fee (R/NR): $42/$63 Min/Max: 6/35 Deadline: 1 week prior to program Door-to-Door Transportation: $10
CUSR Transportation PolicyOur door–to–door routes need to have a minimum of two registrants to run. If a route is canceled, a phone call will be made to the participant and their caregiver, and a full refund will be issued to the participant’s account.
PLEASE VISIT cuspecialrecreation.com 22
Mustang Aquatics Ages 10+Make your way into the water and join us for swim practice! Athletes will have the opportunity to compete in a time trials practice meet and the Special Olympics District meet.
NOTE: You must be able to swim the length of the pool unassisted to register for this program. This is not a swim lesson program. Individuals in the program must have stroke knowledge and be able to swim independently.*Participants must purchase their own swimming suit. One-piece swim suits are required for female swimmers and males may wear swim trunks or jammers. GOALS: Increase cardiovascular fitness, gross motor coordination, improve goal-setting abilities, and improve swimming strokes.
Date Day Program ID Jan 6-Mar 24 Sunday 419546-01 *If the swimmer qualifies for state competition, the season will continue until June 17. Time: 7-8pm Location: Urbana Indoor Aquatic Center Fee (R/NR): $53/$79.50 Min/Max: 4/12 Deadline: December 30 No Door-to-Door Transportation *Medical Applications must be valid through June 17
Mustang Power Lifting Ages 16+Get ready to bench, squat, and more! Work out with Mack and he’ll get you into shape. Training takes place twice a week in preparation for the Special Olympics Qualifier.
*Participants must purchase their own lifting suit and belt for competition. GOALS: Improve overall strength and gross motor coordination, learn and practice weight room safety and etiquette, and improve goal-setting abilities.
Date Program ID Jan13-Apr 14 419545-01 *If the lifter qualifies for state competition, the season will continue until June 17. Day & Time: Sunday, 5-6pm; Thursday, 7:30-8:30pm Location: Stephens Family YMCA Fee (R/NR): $46/$69 Min/Max: 4/8 Deadline: January 7 No Door-to-Door Transportation *Medical Applications must be valid through June 17
Fitness Frenzy Ages 15+Get motivated exercising with a friend! Participants will be paired with a CUSR staff member who will exercise with them for one hour, twice a week, for 8 weeks. Workouts will be planned to meet participants’ individual fitness goals and can be scheduled when it is convenient for both partners. For more information on registration, please contact Kyle Shartzer at 217.239.1152 or [email protected].
GOALS: Increase gross motor coordination and physical fitness and gain knowledge of proper fitness techniques. Date Program ID Jan 7-Feb 25 419542-01
Location: Leonhard Recreation Center Fee (R/NR): $218/$327 Deadline: December 17 No Door-to-Door Transportation
ADULT BOWLING PROGRAM LOTTERY A lottery system was created to provide regis-trants with an equal opportunity to enroll in our
programs. If a program is full and the wait list has a minimum of 4 names, a lottery will be conducted for all who register by the deadline. The lottery will be conducted one week following the registration deadline. Participants who are lotteried out will be placed on a waitlist pending staffing. Any registration received after the deadline will
be processed on a daily basis and added to the waitlist on a first-come first-served basis.
ATHLETICS
PLEASE VISIT cuspecialrecreation.com 23
Strikes & Spares Ages 22+Bring your friends to the bowling alley for some fun! Perfect your skills while socializing with your friends and meeting new ones. Participants will be assigned to lanes and can bowl up to two games.
*Participants arriving late will bowl two games, if time allows. GOALS: Improve social skills, practice bowling etiquette, and increase gross motor coordination. Date Day Program ID Transportation ID Feb 4-Apr 22 Mon 419544-01 419544-T1 Feb 6-Apr 24 Wed 419544-02 419544-T2
Time: 4-5pm Location: Western Bowl Fee (R/NR): $84/$126 Min/Max: Mondays – 4/20; Wednesdays – 4/25 Deadline: January 28 Home-Only Transportation Fee: $60
Teen Pins Ages 13-21Perfect your skills while socializing with your friends and meeting new ones. Participants will be assigned to lanes and can bowl up to two games.
*Participants arriving late will bowl two games, if time allows. GOALS: Improve social skills, ability to interact with others, practice bowling etiquette, and increase gross motor coordination. Date Day Program ID Transportation ID Feb 4-Apr 22 Mon 419543-01 419543-T1 Time: 4-5pm Location: Western Bowl Fee (R/NR): $84/$126 Min/Max: 4/8 Deadline: January 28 Home-Only Transportation Fee: $60
Mustang Track & Field Ages 13+There is something for everyone at Track & Field! You can train for field events, running, walking, sprints, long distance, and wheelchair races. Athletes have the opportunity to compete at the District Track & Field meet.NOTE: Please wear appropriate athletic clothing to practice – athletic shorts or sweatpants, t-shirts, and tennis shoes. Jeans and sandals of any kind are not allowed at practice. GOALS: Increase gross motor coordination, improve athletic abilities and improve communication and listening skills.
Date Program ID Transportation ID March 6-May 1 419548-01 419548-T1 *If the athlete qualifies for state competition, the season will continue until June 17. Day: Wednesday Time: 6:30-7:30pm Location: University of Illinois Armory & Leonhard Recreation Center Fee (R/NR): $41/$61.50 Min/Max: 6/25 Deadline: February 27 Door-to-Door Transportation: $90 *Medical Applications must be valid through June 17
C-U Kiwanis Tom Jones Challenger League Ages 6-21 The Challenger League is a cooperative program between C-U Kiwanis Club and CUSR. Challenger baseball gives players with physical and/or intellectual disabilities the opportunity to play the game of baseball. Uniforms, caps, and equipment are provided for the games. Players either hit from a tee or swing at a pitched ball and are assisted by coaches, volunteers, and “buddies”. Please contact Tom Grey at 217.337.2998 if you have any questions regarding the league.
Date Program ID May and June 419547-01 Day: Tuesday evenings & Saturday mornings Time: TBA Location: Ambucs Park, Urbana Fee (R/NR): $25 Deadline: March 27 No Door-to-Door Transportation
PLEASE VISIT cuspecialrecreation.com 24
SPECIAL OLYMPICS
Special Olympics Illinois provides year-round sports training in a variety of Olympic-type sports for youth, teens and adults with intellectual disabilities who are 8 years of age or older. CUSR supports the mission of Special Olympics Illinois through participation in the following sports: – AQUATICS
– BASKETBALL – BOCCE
– BOWLING – POWER LIFTING – SOFTBALL
– TRACK & FIELD – VOLLEYBALL – FLAG FOOTBALL
January 13 Men’s District Basketball, Bloomington March 15-17 State Basketball, Bloomington April 6 District Aquatics, Urbana April 14 Power Lifting Qualifier, Granite City May 5 District Track, Champaign
IMPORTANT SPECIAL OLYMPIC DATES
CRITERIA FOR PARTICIPATIONAll Special Olympics athletes must have a current, completed Application for Participation in Illinois Special Olympics form on file with the Athletics Coordinator at CUSR. This form has four sections:
1. Athlete Information 2. Parent / Guardian Authorization & Medical Authorization 3. Health Insurance and Emergency Information 4. Medical Clearance *Must be completed by PhysicianApplications for Participation in Illinois Special Olympics are valid for 2 years based on the earliest signed date on the medical application form. Anyone interested in participating, starting a new sport, or volunteering, please contact: Shelbie Kearfott, CUSR Athletics Coordinator at 217-239-1152.
25
PARTICIPANT NAME
ADDRESS PHONE (H)
PHONE (W)
CITY ZIP
BIRTH DATE AGE SEX SHIRT SIZE EMAIL
PRIMARY DISABILITY
PARENT/GUARDIAN PHONE (H) PHONE (C)
EMERGENCY NAME PHONE (H) PHONE (C)
DOCTOR’S NAME PHONE
PREFERRED HOSPITAL
ALL INFORMATION BELOW MUST BE COMPLETED FOR FORM TO BE PROCESSED.ANY FORM NOT COMPLETELY FILLED OUT WILL BE RETURNED TO PARTICIPANT.
MAIL CUSR • 1311 W. Church St., Champaign, IL 61821FAX 217-373-7951 ONLINE cuspecialrecreation.comQUESTIONS (phone) 217-239-1152 • 711 Relay
PROGRAM NAME CODE PICK UP POINT TRANSPORT CODE FEE
1.
2.
3.
4.
5.
Would you like to make a donation to the CUSR scholarship fund? $5.00 $10.00 Other
Fee Waiver/Scholarship applied for? ________ NO ________ YES (If yes, please attach)
CUSR may use pictures and videos taken at programs for publicity purposes. Is this okay? __________ Yes __________ No
List Medications:
List Allergies:
List Dietary Restrictions:
List Special Needs/Assistance Necessary:
Please circle all that apply: Wheelchair: manual/electric Nonverbal Sign Language Close Supervision Seizures Cane/Walker Atlantoaxial Subluxation Condition
Participant’s name
Participant’s signature* Date* (18+ YEARS OR PARENT/GUARDIAN) * Participation can be denied if the signature of adult participant or parent/guardian and date are not on this waiver. Please call 217.239.1152, if you require special accommodations.
SEE BACK OF FORM FOR CREDIT CARD PAYMENT INFORMATION
REGISTRATION FORM
PLEASE SEE FRONT SIDE FOR WAIVER. THE WAIVER MUST BE SIGNED BEFORE YOUR REGISTRATION MAY BE PROCESSED
Please make checks payable to CUSR. Complete below when using VISA/MasterCard
Account Number
3-4 Digit CCID# (on back of card) Expiration Date
Authorized Signature Charge Amount
Important information CUSR is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. CUSR continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the partic-ipants’ safety. However, participants and parents/guardians of minors registering for the CUSR programs/activities must recognize that there is an inherent risk of injury when choosing to participate in recreational activities/ programs. You are solely responsible for determining if you or your minor child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way, or recently suffered illness, injury, or impairment, to consult a physician before undertaking any physical activity.
Warning of risk Recreational activities/programs are intended to challenge and engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity/program. Understandably, not all hazards and dangers can be foreseen. Depending on the particular activity, participants must understand that certain risks, dangers and injuries due to inclement weather, slipping, falling, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, premises defects, inadequate or defective equipment, inad-equate supervision, instruction or officiating, and all other circumstances inherent to indoor and outdoor recreational activities/programs exist. In this regard, it must be recognized that it is impossible for CUSR to guarantee absolute safety.
Waiver and release of all claims and assumption of risk Please read this form carefully and be aware that in signing up and participating in CUSR programs/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided).
I recognize and acknowledge that there are certain risks of physical injury to participants in these pro-grams/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in these program/activities against CUSR and Champaign and Urbana Park Districts, including their respected officials, officers, employees, and volunteers (hereinafter collectively referred as “CUSR”). I do hereby fully release and forever discharge CUSR from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities. I have read and understand the above important information, warning of risk, assumption of risk and waiver and release of all claims.
26
APP
LIC
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ATH
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INFO
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nam
ed a
pplic
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here
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d to
as
the
“Ent
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mis
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n on
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f Ent
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to S
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nd o
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nd in
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dver
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spon
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t Spe
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mpi
cs a
ctiv
ities
in w
hich
the
Entra
nt is
to c
ompe
te, s
o as
to b
e co
nsul
ted
in c
ase
of n
eces
sity
, you
are
aut
horiz
ed o
n m
y be
half
and
atm
y ac
coun
t to
take
suc
h m
easu
res
and
arra
nge
for s
uch
med
ical
and
hos
pita
l tre
atm
ent a
s yo
u m
ay d
eem
adv
isab
le fo
r the
hea
lth a
nd w
ell-b
eing
of t
he E
ntra
nt.
I, TH
E U
ND
ERSI
GN
ED A
DU
LT E
NTR
AN
T,ha
ve re
ad a
nd fu
lly u
nder
stan
d th
e pr
ovis
ions
of t
he a
bove
rele
ase
and/
or h
ave
had
them
exp
lain
ed. I
her
eby
agre
e th
at I
will
be b
ound
ther
eby
and
I sha
ll de
fend
Spe
cial
Oly
mpi
cs Il
linoi
s an
d ho
ld it
har
mle
ssfro
m d
isaf
firm
atio
n th
ereo
f.
Entra
nt
Witn
ess
Dat
e
Athl
ete’
s Em
ail A
ddre
ss
I, TH
E U
ND
ERSI
GN
ED P
AR
ENT
AN
D/O
R G
UA
RD
IAN
of th
e ab
ove
spec
ified
Entra
nt, h
ave
read
and
fully
und
erst
and
the
prov
isio
ns o
f the
abo
ve re
leas
e an
d ha
veex
plai
ned
them
to s
aid
Entra
nt. I
her
eby
agre
e th
at I
and
said
min
or w
ill be
bou
ndth
ereb
y, a
nd I
shal
l def
end
Spec
ial O
lym
pics
Illin
ois
and
hold
it h
arm
less
from
any
di
saffi
rmat
ion
ther
eof b
y sa
id m
inor
.Si
gnat
ure
of P
aren
tan
d/or
Leg
al G
uard
ian
(Che
ck a
ppro
pria
te b
ox)
Prin
t Nam
eD
ate
Pare
nt’s
Em
ail A
ddre
ss
PLEA
SE C
HEC
K M
EDIC
AL
INFO
RM
ATIO
N
Doe
s at
hlet
e ha
ve D
own
Synd
rom
e?Ye
sN
oIf
yes,
hav
e x-
rays
of t
he C
1-C
2 ve
rtebr
ae
been
take
n an
d ex
amin
ed?
Yes
No
Dat
e of
x-ra
yIs
the
athl
ete
clea
rof A
tlant
oaxi
al In
stab
ility?
Yes
No
Doe
s th
e at
hlet
e ha
ve o
r is
the
athl
ete:
Hea
rt Pr
oble
ms
Yes
No
Dia
betic
Yes
No
Epile
ptic
/Sei
zure
sYe
sN
oBl
ind
Yes
No
Dea
fYe
sN
oH
epat
itis
Yes
No
Oth
er
Cur
rent
Med
icat
ion
Dos
age
Alle
rgie
s to
med
icat
ion,
if a
ny:
Dat
e of
last
Tet
anus
sho
t:
I hav
e ex
amin
ed th
e ab
ove-
nam
ed E
ntra
nt
and,
in m
y op
inio
n, th
ere
is n
o m
enta
l or
phys
ical
reas
on w
hy h
e or
she
sho
uld
not
parti
cipa
te in
the
Spec
ial O
lym
pics
spo
rts
train
ing
and
com
petit
ion
prog
ram
. Fur
ther
in
form
atio
n w
ill be
forw
arde
d if
requ
ired.
Cur
rent
med
icat
ion,
if a
ny, i
s sp
ecifi
ed w
ith
dosa
ge o
n th
is a
pplic
atio
n.
Exam
inat
ion
Dat
e
Doc
tor’s
Sig
natu
re
Prin
t Nam
e
Addr
ess
City
Stat
e Zi
p
Phon
e (
)
SOIL
LO
FFIC
EO
NLY
Zip
Cod
e
-
Stat
e
Pare
nt’s
/Gua
rdia
n’s
City
Ethn
icity
Whi
teB
lack
/Afr
ican
Am
eric
anH
ispa
nic/
Latin
oO
ther
Asi
an
Orig
inal
par
ent/g
uard
ian
and
doct
or s
igna
ture
s ar
e re
quire
d by
the
offic
e of
Spe
cial
Oly
mpi
cs Il
linoi
s. F
axed
sig
natu
res
will
notb
e ac
cept
ed.
SOIL
LR
ev. 8
-1-1
0
27
Instructions for Completing the Application for ParticipationThe Application for Participation (App) must be filled in completely. Apps with blank sections or attachments (exception: let-ter from State Office of Guardianship, 2a below) will not be accepted.
This App is valid for 2 years from the date of the examination date, regardless of the parent/guardian/Entrant signature date.
Parent/guardian and doctor signatures must be original and both original signatures must be on the same App form. Faxedsignatures, phone consents or verbal consents will not be accepted.
If Entrant was listed on the Sex Offender Public Registry or the Child Murder and Violent Offender Against Youth Registrybut has since been removed, contact the Special Olympics Illinois office for instructions before submitting this application.
ATHLETE INFORMATION AND HEALTH INSURANCE & EMERGENCY INFORMATION1. The first two sections must be filled in completely. The ethnicity information is requested to assist in the organizational outreachefforts.
PARENT AND/OR GUARDIAN AUTHORIZATION AND MEDIA RELEASE2. The Parent or Legal Guardian must read, sign and date the Parent/Guardian Authorization and Media Release.
a. The section must be signed and dated as printed. Deletions or alterations to the section will result in an invalid App.(Exception: Deletion of the last paragraph regarding medical treatment and attachment of a letter of explanation and 24-hour emer-gency telephone numbers from the State Office of Guardianship. As of January 1, 1987, the letter of explanation must beattached.)
b. Only one of the two signature blocks must be completed. Special Olympics Illinois works under the understanding that thissection may be signed by either:
The (biological or adoptive) parent unless the athlete has been designated a ward of the state;OR
The legal guardian; this person must be legally assigned for the individual;OR
The athlete if he/she is over the age of 18 and has not been designated as needing and having been assigned a legal guardian.A witness signature is necessary if the athlete’s signature is unrecognizable (for example, if the athlete’s signature is an “X.”)
MEDICAL CLEARANCE3. The Medical Clearance section must be completed, signed and dated by a medical practitioner licensed to administer physicalexaminations by the state in which he/she practices. As of September 1, 1990, the Special Olympics Illinois Application forParticipation is the only Medical Clearance form which will be accepted as valid by Special Olympics Illinois.
This person, by signing the Medical Clearance, is stating that the athlete is in good health and can safely participate in SpecialOlympics sports training and competition. It is strongly suggested that the person administering the physical examination possess thefollowing:
Background and preparation in giving sports physical examinations.Qualifications to administer examinations that would not compromise his/her area of specialty.
AFTER COMPLETING THE APPLICATION ...4. Send the original copy of the Application for Participation to the Area Director who will send the App to the Special OlympicsIllinois Chapter office. The Chapter office will validate the Application for Participation and send a copy of the App with anapproved stamp back to the SOAD (Special Olympics Athletic Director). An Application for Participation will not be validated untilall information is correct and completed on the approved form.
5. Special Olympics Illinois requires that all Applications for Participation be presented prior to and no later than the establishedMedical App deadline of a Chapter championship level event (Winter Games, State Basketball Tournament, Summer Games,Outdoor Sports Festival, Fall Games, Floor Hockey or State Bowling Tournament). All Apps for the event in question must be validthroughout the completion of that Chapter competition.
Applications for Participation for athletes participating in District Tournaments and Sectional Tournaments must be received beforethe entry deadline or with registration materials.
Applications not on file or in receipt by the specified deadline will not be accepted.
28
Late Pick-Up PolicyIn order to be fair to our participants and program leaders, CUSR has enacted a late pick-up policy. The first time a participant is not picked up within a 5 minute grace period, a written warning will be handed out. For each minute following the grace period, a fee of $1/per minute will be charged to the parent or guardian. Registration for other programs will not be accepted until all outstanding late fees are paid. Thank you for helping us to respect others through punctual pick-ups.
Satisfaction GuaranteedCUSR constantly strives to provide participants with high quality recreation programs, activities, and events. To encourage first-time participation, as well as repeat participation, CUSR has a refund policy highlighted by a satisfaction guarantee. This special refund policy provides us with timely feedback about dissatisfaction regarding our services. If you are not completely satisfied, tell us, and we will either invite you to repeat the class at no charge, allow you a credit that can be applied to another program, or issue you a refund. A refund will be granted if you were dissatisfied with the experience due to circumstances under CUSR’s control. If you are not satisfied, we kindly ask you to give us your input or ideas for improvement. Requests for the above mentioned options must be made before the midpoint of the program or within two weeks of a single meeting activity. All refund requests must be submitted on the Satisfaction Refund Request form and turned into CUSR. A $5 service charge will be deducted from all refunds. Satisfaction Guarantee does not apply to trips and special events with prepaid admissions and tickets.
Program Cancellation PolicyAll registration cancellations must be made at least one week prior to the start of the program in order to receive a full refund. For programs with cancellation dates listed, registration must be canceled no later than the specified date to receive a full refund. Any program cancellations after the one week deadline will receive NO refund. A $5 service charge will be deducted from all refunds.
Program ScholarshipsBecause some residents are unable to participate in recreation programs due to economic hardship, CUSR provides a scholarship policy to reduce certain fees and charges. Scholarship applications are not guaranteed and are based on available funds, program registration, or choice of program location. Early applications are given priority. Please apply 3-4 weeks before the program start date. Applications are available at the CUSR office and can be mailed upon request. Need is the primary criteria upon which scholarship applicants are considered. Scholarships are not available for transportation and specifically identified programs. For more information, call 217-239-1152. Payment plans available to all. ALL monies owed must be paid prior to next season registration accepted.
Inclement Weather PolicyIf inclement weather occurs, CUSR may still decide to hold programs. If the weather turns dangerous, CUSR will call participants prior to the start of the program to cancel the program. If you are unsure whether a program will meet due to inclement weather, call CUSR. Missed programs due to weather may be made up the week after the end of the program season. Credit is given for additional cancellations.
CUSR INFORMATION
Extreme Temperature PolicyHot temperatures (for outdoor programs) at program time: 100oF actual temperature; heat index of 110oF or more constitutes canceling program due to unsafe conditions.Cold temperatures (for all programs) at program time: 2oF actual temperature; -30oF or below wind chill constitutes canceling program due to unsafe conditions.
Participant Expectations1. Participants need to wear appropriate attire for
program participation (i.e. for athletic/fitness programs comfortable clothing and tennis shoes must be worn). If you have questions about the type of attire participants should wear for a particular program, please contact our office.
2. Participants need to have clean, dry clothing.3. No bowel/bladder problems upon arrival at the
transportation location or program. (If this is a concern, extra clean clothing, clean-up supplies and Depend garments (or similar items) must be sent with the participant).
4. Participants need to pay attention to body odor and overall appearance (clean hair, face, teeth, hands, etc.). CUSR staff will also be consistent in stressing personal hygiene while participants are in our programs and will not return participants at the end of a program in an unclean manner.
29
Transportation Policy/Safety Procedures1. Transportation must be requested at least 48
hours prior to the program date. If transportation is requested with less than 48 hours from program date, there is no guarantee transportation will be available. NO transportation request at the time of the program will be accepted.
2. A minimum of two participants must register for transportation in order for it to run.
3. Transportation is provided from YOUR home back to YOUR home. We will not pick up or drop off at any other sites.
4. CUSR staff will wait a maximum of 5 minutes past your pickup time due to a demanding van schedule. If you miss your pickup time, we will not return to pick you up. It is your responsibility to find transportation to the program if you miss your pickup time.
5. CUSR transports in-district participants only. 6. Transportation will only be provided for those who
sign up and pay for the service at the beginning of the program. We will not provide transportation for anyone mid-season that is not on the transportation roster at the beginning of the program.
7. Persons unable to be in a house alone should have someone meet the van at the designated time of return.
8. If needed, the CUSR driver will assist participants to and from their homes, but driveways and walkways must be clear of debris and obstacles.
9. All passengers must be sitting in seats or wheelchairs with belts securely fastened in the correct manner or the driver will not move the vehicle.
10. CUSR staff is responsible for determining whether or not a participant can be transported safely.
11. Persons riding in Amigo-type wheelchairs or strollers must transfer into a vehicle seat and use a seat belt.
CUSR reserves the right to refuse to transport individuals. These policies have been developed to ensure safety of everyone riding in CUSR vehicles.
DisciplineA caring, positive approach will be used regarding discipline. CUSR reserves the right to dismiss participants. Each situation will be evaluated on its own merit.
Behavior CodeCUSR promotes the concept of “Equal Fun For Everyone” and strives to accomplish this belief through our program goals. However, certain rules are necessary to ensure everyone’s safety and enjoyment. CUSR participants are expected to exhibit appropriate behavior at all times. The CUSR behavior code states that participants shall show respect to all participants and staff, refrain from using foul language, refrain from causing bodily harm, and show respect to equipment, supplies, and facilities. Additional policies may be developed for specific programs and camps.
InsuranceIndividual accident liability insurance is not provided by CUSR.
Dishonored ChecksA $25 service charge will be assessed on all checks returned by the bank for any reason.
Emergency ContactsEmergency phone numbers may be used for reasons other than an actual emergency situation. If staff needs to communicate any unforeseen change(s) of plans, transportation schedule adjustments, etc., and neither parent/guarding can be reached, the emergency contact is our only source to call. Please help us reduce any anxiety created with these calls by letting your designated “emergency contact” know that they may be called for other situations. Your assistance is appreciated.
Atlanto-Axial SubluxationIndividuals with Downs Syndrome are at risk of having a condition known as Atlanto-Axial Subluxation. CUSR must have a doctor’s written note on file stating a participant is free of the instability if he/she wishes to participate in programs that may cause undue stress upon the neck. Please take this into consideration when registering and inform staff if the condition is present.
CUSR INFORMATIONCONTINUED
30
CUSR Picture RequestDo you have some great pictures of programs or events? Please email them to [email protected] or bring electronic files to Hays Recreation Center.
Follow us on FacebookTo stay connected to all the happenings, find us on Facebook and see what’s going on! Facebook.com/CUSpecialRec
Program IdeasDo you want to try out a new food place? Have you wanted to see a play or hear live music at a new venue? We are always looking for new ways to learn, grow, and play! If you have a new idea for a program let us know by calling 217-239-1152 or emailing [email protected].
Autism NetworkBest BuddiesBlack Dog SmokehouseBody N' SoleChampaign County Forest Preserve DistrictChampaign County Penguin ProjectChampaign Gymnastics AcademyChampaign-Urbana MTDCommunity Learning Labs - UIUCCommunity ChoicesCU-Able
Developmental Services Center (DSC)Down Syndrome NetworkHamilton Walker'sHealing Horse StablesHeart of Illinois Special Recreation Association (S.O.A.R.)Heartland BankKessler OpticalOrpheum Children's Science MuseumP.A.C.ERewind 92.5Stephen's YMCA
Thank You to our Program Partners!
31
32
SUN
JAN
UA
RY20
19M
ON
TUE
WED
THU
FRI
SAT
1 8 15 22 29
2 9 16 23 30
3 10 17 24 31
4 11 18 25
5 12 19 26
6 13 20 27
7 14 21 28
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W T
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52
cusr
@ch
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cu
spec
ialre
crea
tion.
com
33
SUN
FEB
RU
ARY
2019
MO
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UFR
ISA
T
5 12 19 26
6 13 20 27
7 14 21 28
1 8 15 22
2 9 16 23
3 10 17 24
4 11 18 25
- THE
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101
- ILLI
NI B
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TBAL
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- THE
ATRE
101
- DIN
NER
& BO
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- THE
ATRE
101
- ISU
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- THE
ATRE
101
- AFT
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CHO
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- AFT
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CHO
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- VAL
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NE’S
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DAN
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- AFT
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& S
PARE
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NIG
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- AFT
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cu
spec
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com
34
SUN
MA
RC
H20
19M
ON
TUE
WED
THU
FRI
SAT
5 12 19 26
6 13 20 27
7 14 21 28
1 8 15 22 29
2 9 16 23 30
3 10 17 24 31
4 11 18 25
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cu
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7.23
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cusr
@ch
ampa
ignp
arks
.com
cu
spec
ialre
crea
tion.
com
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