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The City of Coquitlam strives to provide accessible recreation opportunities for children and youth. After reviewing this form, a Community Services Coordinator will be in contact with you to discuss your child’s recreation support plan.
A recreation support plan can support your child’s experience by:
- Providing key information to program leaders
- Employing strategies such as: having resources including visual cards and noise cancelling headphones available & ensuring program spaces meet accessibility requirements
Our ability to accommodate may depend on:
- Level of support requested and available resources at the time of registration
- Behaviours beyond the scope of a recreation support plan may include: physical and verbal aggression, wandering/running from the group, other behaviours placing staff and/or participants in unsafe situations
- Recreation staff do not administer medication or directly assist with feeding, dressing or toileting
- Ensuring program spaces meet accessibility requirements
Please note: recreation staff and volunteers do not support participants in a one-to-one capacity. Caregivers can arrange for their own support person (EA, BI), trusted family member or friend (over 16 years) to accompany their child if needed.
- One-on-one support opportunities are not guaranteed and if available are allocated on a needs basis.
- Patrons who require direct support to safely enjoy our services can bring a support person with them at no additional cost. It is expected the support person will be with the customer throughout their visit and be fully engaged in supporting them. Please let the front know upon arrival.
For late registrations such as waitlist openings or any withdrawals, contact us directly at 604-927-6076
Any registrations not listed on this form require completion of a NEW request form.
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Applicant Information

Parent / Guardian Information

Parent/Guardian Full Name
Address
Home Phone
Mobile Phone
Work Phone
Email Address
Emergency Contact Name
Emergency Contact Phone Number
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Registered Recreation Programs Information

Program 1
Program Name
Barcode / Identification Number
Date / Time
Date / Time
Date / Time
Location
Program 2
Program Name
Barcode / Identification Number
Date / Time
Date / Time
Date / Time
Location
Program 3
Program Name
Barcode / Identification Number
Date / Time
Date / Time
Date / Time
Location
Program 4
Program Name
Barcode / Identification Number
Date / Time
Date / Time
Date / Time
Location
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Details About My Child

How does my child react to change and new environments?
What are my child’s strengths and limitations?
What are my child’s interests and preferred activities?
Strategies used at home and/or school that help my child to learn and play?
Strategies used when my child is feeling: (ex. redirection, taking a break etc.)
What does my child look like or behave like when they're frustrated or angry?
What does my child look like or behave like when they're overwhelmed or overstimulated?
What does my child look like or behave like when they're discouraged or sad?
What else is important to know about your child?
I understand that my child’s recreation support plan may need to be adjusted/updated over time.
1. I acknowledge
I acknowledge that due to the uniqueness of recreation environments, strategies may not always be effective. In some cases, staff may need to withdraw a participant from the program.
1. I understand
Freedom of Information and Protection of Privacy Act
By submitting this form you are consenting to the collection, use and disclosure of your personal information in accordance with Sections 26, 32, and 33 of the Freedom of Information and Protection of Privacy Act. The City has authority to collect your information for the purposes of administering the City’s Recreation Inclusion Program You are also consenting to the sharing of your personal information with 3rd party service providers. Should you have any questions or concerns about the collection of your personal information please email Community Services .

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1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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