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Passport to Recreation Profile
because there's more to life than just work

The following guide is designed to help you plan meaningful participation in community activities. Please complete the form below, and you'll be on your way to new experiences and enjoyable recreation! If you need assistance filling out this form, please contact Adaptive Recreation Opportunity's Therapeutic Coordinator, Renee Lee at 224-6027.

Passport to Recreation Profile
1. General Information
(all questions in this section are required)
 First Name:    Last Name:
 Address:
 City:    State:    Zip: 
 Phone:  Email:
Support Person
Support Person's
Phone No.
Where did you receive information regarding Passport To Recreation?
CCP
Foothills Gateway
ARO
School 		Internet
DVR Rehab
Other
2. What activities are you interested in? Check any of the following categories and if you have specific interests, please list them.

Social (e.g. attending dances, going out to dinner, etc.)
specific interests:

Arts (e.g. painting, drawing, pottery, etc.)
specific interests:

Sports (e.g. softball, swimming, bowling, etc.)
specific interests:

Events (e.g. going to theatre shows, sporting events, museums, etc.)
specific interests:

Other
specific interests:

3. Please check any of the following barriers that may be preventing you from participating in recreational activities.

I need assistance to participate.
Paying for activities
I don't know what activities are available.
I don't know how to sign up.
I need someone to go with.
Transportation
Adaptive equipment
Other
I do not have any barriers.

4. Please list three activities that you would most like to do:

1.

2.

3.

5. Now that you have finished the Passport to Recreation Profile, you're ready to begin your adventure!

Press the submit button below to send your Passport Profile to the ARO program. If you have any questions, please call Renee Lee at 224-6027.

*This project was funded by Recreation Works, a grant project funded by the U.S. Department of Education (#H128JO10116).