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Passport to Recreation Profile

because there's more to life than just work

Are you interested in finding out about recreation and leisure programs that are right for you? Would you like ideas on what kind of activities are scheduled, how to get registered, what kind of accommodations are available to assist you to fully participate and enjoy recreation as independent as possible? Do you want to meet new friends, be active and have fun? If you have answered yes, then don't spend another day sitting at home when you can be having the adventures of your life. Take the first step on your exciting journey by completing a Passport to Recreation Profile (see below). A Therapeutic Recreation Specialist will arrange a time to meet with you to help you develop your personal recreation profile and discuss your needs, strengths and interests.

For questions or more information, call Renee Lee at 970.224.6027 or email

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).