Fall 2012

CUSR General Information

Hays Recreation Center 1311 W. Church St. Champaign, IL 61821 Phone: 217-239-1152 Fax: 217-373-7951 711 Relay E-Mail: cusr@cparkdistrict.com Website: www.cuspecialrecreation.com Office Hours: Mon-Fri, 8am-5pm Office Closed: September 3; Novermber 12, 22, 23; December 24, 25

Inclusive Programs Through CUSR

Our Mission

Our five year mission is to advocate for and provide access to a full range of recreational opportunities for people with disabilities to focus on, further define and provide our core programs to create partnerships that will increase participation and programs, ensure financial viability for growth and position CUSR to expand its number of member agencies.

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 individuals 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

Our Vision

CUSR exists to ensure that people with disabilities, within our member agencies, have access to a full range of recreational services. We create equal access to recreation, which is integral to a higher quality of life. We create awareness and advocate acceptance of people with disabilities in their communities so they more fully participate in recreation and all aspects of society.

CUSR is an intergovernmental cooperative made up of the Champaign and Urbana Park Districts, that was 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.

Invite Us To Speak

CUSR staff members are knowledgable 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 CUSRs 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 set up a meeting.

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 the CUSR Director at 217-239-1152.

Program Locations
Champaign
CUSR Office Hays Recreation Center / Eisner Park 1311 W. Church St. 217-239-1152 Arrowhead Lanes 1401 N. McKinley 217-352-5288 Franklin Middle School 817 N. Harris Ave. 217-351-3819 Jupiters at the Crossing 2511 Village Green Pl. 217-366-8300 Spalding Recreation Center 910 N. Harris 217-398-2577 Stephens Family YMCA 2501 Fields South Dr. 217-359-9622 Western Bowl 917 Francis Dr. 217-359-1678
CUSR staff, from left to right: Lisa Morand, Cindy McGrath, Jessica Brutti, Dawn Schaefer, and Hanah Sheets

Whats Inside...
After School .................................3 Youth & Teen Programs ...............3 Adult Programs ............................6 Special Events ........................... 11 Trips ...........................................14 Special Olympics .......................15 Athletics .....................................16 Registration Form ......................19 Waiver and Release...................20 Special Olympic Application.......21 CUSR Information......................23

Savoy

Savoy Recreation Center 402 W. Graham Dr. 217-359-3550

Urbana
Brookens Gymnasium 1776 E. Washington 217-344-9583 Anita Purves Nature Center 1505 N. Broadway 217-384-4062 Phillips Recreation Center 505 W. Stoughton 217-367-1544 Urbana Indoor Aquatic Center 102 E. Michigan 217-384-7665

CUSR Staff
Dawn Schaefer, MS, CTRS - Director Hannah Sheets, MA, CTRS - Athletics Coordinator Jessica Brutti, CTRS - Adult Coordinator Lisa Morand, CTRS - Youth & Teen Coordinator Cindy McGrath - Receptionist

Find us on Facebook and stay connected Champaign-Urbana Special Recreation

For a large-print version of this brochure, contact the CUSR office at 239-1152.

Welcome
All residents of Champaign-Urbana are important to us! If you are new to the area, Champaign-Urbana Special Recreation invites you to come in and find out what we have going on for you and other members of your family. Throughout the year, we provide a large variety of social, recreational, cultural and sports activities for all ages and abilities. To learn more about what we have to offer, give us a call at 217-239-1152. We will be happy to explain any program or service that is of interest to you. As a potential program participant, we would like to meet with you and your family!

CUSR Transportation Policy

Our doortodoor routes need to have a minimum of 2 registrants to run. If a route is cancelled, a phone call will be made to the participant and their caregiver, and a full refund will be issued to the participants account.

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 Bresnan Meeting Center 706 Kenwood Road, Champaign Douglass Community Center 512 E. Grove Street, Champaign Leonhard Recreation Center 2212 W. Sangamon Drive, Champaign Springer Cultural Center 301 N. Randolph Street, Champaign Or register online at www.cuspecialrecreation.com *Please note: Online registration is not live, so does not guarantee entry into program. 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 above, through mail, 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.

Medication
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.

Certified Therapeutic Recreation Specialist (CTRS)

The 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. 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.

Non-Resident Program Fees

Participants that do not pay property taxes in Champaign or Urbana will be required to pay 50% more than residents for programs. The NR listed next to the program fee is the Non-Resident fee.

Early Childhood
Developmental Play Group
New!

Youth and Teen

After School Program
Ages 5-22
Come join your friends for an afternoon filled with games, sports, arts and crafts, cooking, and field trips. We will offer an amazing, as well as safe, atmosphere where we will laugh, play, grow and learn new skills. GOALS: To improve verbal and social skills, build new friendships and gain self-confidence and independence. To expand knowledge of leisure activities. Date Sept. 4, 2012May 24, 2013 Time 2:30-5:30pm Program ID 232104-A1

Ages 2-6 with parent/guardian

Play is a great way to address many therapeutic goals all while smiling and laughing. These small groups explore the many aspects of play that will allow your child to laugh, learn and grow. The classes will be held at the Stephens Family YMCA in the Family Adventure Center and Sensory Rooms. Parents will be actively involved for half of the class and will be allowed to have some time in the Resource Library to network with the other families involved. Classes will be led by a Recreation Therapist. Registration taken at the Stephens Family YMCA.

Music Therapy

New!

Ages 0-6 with parent/guardian

The goal of music therapy is to use specifically designed music and music activities to accomplish non-musical goals. Learning through music therapy is a great way to have fun, interact socially, encourage communication through singing, movement, expressiveness and to learn new skills. Class is lead by a Board Certified Music Therapist. Come ready to sing, move and try out some instruments. Registration taken at the Stephens Family YMCA.

Day: Monday-Friday Location: Spalding Recreation Center Fee (R/NR): $192/$288 Min/Max: 8/15 Deadline: One week prior to month starting *No Program: September 27 October 25-26 November 22-23 December 24-January 4 January 7, January 21 February 18 March 15, March 18-22, March 29 April 26 NOTE: This program runs following the Champaign Unit 4 schedule.

www.cuspecialrecreation.com

Youth & Teen Special Events

Martial Arts
Ages 16-35

Urbana Indoor Aquatic Center

Ages 7-13
Urbana Indoor Aquatic Center is a great place to splash around and have some fun! We will enjoy the zero-depth entry, water geysers, a mushroom waterfall, and slides. So get on your bathing suit and come join us for a good time! Please eat lunch before you come and be in your swimsuit. GOALS: Increase socialization and peer interaction, explore different activities within a water setting, and improve swim skills. Date September 29 Time 1:30-3pm Program ID 232401-A1

(formerly Taekwondo)
Come experience the art of Taekwondo and gain overall exposure to the martial arts. CUSR has partnered with Tina and Jeff Newberry of Leaders for Life/ Newberrys 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. The fee does not include a uniform. The cost for a uniform is $45 payable to Leaders for Life Martial Arts. Uniform sizes will be determined at the first class and you will receive your uniform at the second class. Promotion tests (at an additional cost) are optional, but recommended. 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 Newberry GOALS: To increase concentration and balance, and improve coordination, gross motor skills, endurance, flexibility, and balance. It will also focus on self-confidence and self-defense. Date September 12December 26 Day Wednesday Program ID 232806-A1

Day: Saturday Location: Urbana Indoor Aquatic Center Fee (R/NR): $17/$25.50 Min/Max: 4/8 Deadline: September 21 Transportation: Drop off at Aquatic Center at 1:15pm, pick up at 3pm

Curtis Apple Orchard

Ages 6-13
Come and join your friends as we explore the orchard and pick our own apples! There will be a variety of apples to choose from; Jonathan, Golden Delicious, Red Delicious, Red Fuji and more. Apples range from very sweet to tart so there will surely be an apple for your taste bud! CUSR will pay for lunch. Please bring money for apples and any other souvenirs. GOALS: To increase independence and decision making skills, to increase socialization, and to explore our senses. Date October 13 Time 11am-12:30pm Program ID 222404-A1

Time: 6-6:45pm Location: Stephens Family YMCA, 2501 Fields South Drive, Champaign located off Windsor Rd, over the bridge at I-57. Classroom 118. Fee (R/NR): $161/$241.50 Min/Max: 4/12 Deadline: September 7

Scholarships & Payment Plans Available

Day: Saturday Location: Curtis Apple Orchard Fee (R/NR): $18/$27 Min/Max: 6/12 Deadline: October 5 Transportation: Drop off at Hays Center at 10:40am and pick up at Hays Center at 12:45pm

Lunch Club
Ages 13-18
Whats for lunch today? Come and join your friends as we head out and experience different restaurants and food around town. CUSR will pick up the tab for lunch; you just have to join the club! GOALS: To increase socialization, work on money management skills, and learn dining etiquette skills. Date September 22 October 20 November 17 December 8 Location Program ID Pancheros 232402-A1 Monicals Zas (on Neil) El Toro (on Springfield)

Youth & Teen Special Events

Winter Break Camp
Ages 7-High School Graduate
Looking for something fun to do over your Winter Break? Then your search is over, because this program provides fun for all. Activities include playing games, cooking, making cool projects, and a field trip. Please bring a lunch daily. GOALS: To enhance social skills, learn new leisure activities, and increase independence. Date December 26-28 December 31 January 2-4 Day Wed-Fri Mon Wed-Fri Program ID 232603-A1 232603-A2 232603-A3

Day: Saturday Time: 11:30am-12:30pm Fee (R/NR): $52/$78 Min/Max: 6/12 Deadline: One week prior to program Transportation: Drop off at Hays Center at 11:10am and pick up at Hays Center at 12:45pm

Pottery Place
Ages 13-18
If you enjoy painting pottery then Pottery Place is the place for you. Come and enjoy the relaxing and inspiring space with your friends where you can create your own piece of pottery and use your creativity. Studio time is included in the fee as well as $12 for a piece to pick out. If you wish to spend more than $12 please bring your own money. GOALS: To increase independence, to enhance creativity, and to improve fine motor skills. Date December 15 Time 10:30-11:30am Program ID 222405-A1

Time: 9am-3pm Location: Spalding Recreation Center Fee (R/NR): December 26-28: $106/$159 December 31: $36/$54 January 2-4: $106/$159 Min/Max: 6/12 Deadline: December 17

Day: Saturday Location: Pottery Place Fee (R/NR): $19/$28.50 Min/Max: 6/12 Deadline: December 10 Transportation: Meet at Pottery Place at 10:15am and pick up at 11:30am

www.cuspecialrecreation.com

Adults ~ Monday

CUSR Transportation Policy

Our Door-to-Door routes need to have a minimum of 2 registrants to run. If a route is cancelled, a phone call will be made to the participant and their caregiver and a full refund will be issued.

Computers 101
Ages 16+
Microsoft Word, Access, Excel, emaildoes this all sound confusing to you? Would you like to learn more? Then come on over and learn how its done. Please register for one session per date. New learners take priority in registration. GOALS: To enhance fine motor skills and increase computer knowledge.

Cookin Across the World

Ages 18+
Measure, chop, stir and cook! Join us as we prepare recipes from across the world. We will have themed dinners where we will learn about different cultures and how they prepare their meals. Themes include Italian, Mexican, and Chinese. You will receive a recipe book of the meals we prepared that evening to try at home. GOALS: To enhance cultural awareness, develop appropriate dining etiquette, and improve cooking skills. Date September 10 October 1 November 5 December 3 Program ID 242537-A1 242537-A2 242537-A3 242537-A4 Transportation ID 242537-T1 242537-T2 242537-T3 242537-T4

Date September 17 October 8 November 19 December 10

Program ID 232606 232606 232606 232606

Sess 1 A1 A4 A7 B1

Sess 2 A2 A5 A8 B2

Sess 3 A3 A6 A9 B3

Day: Monday Time: Session 1: 4-4:30pm Session 2: 4:30-5pm Session 3: 5-5:30pm Location: Hays Recreation Center Fee (R/NR): $7/$10.50 Min/Max: 1/3 Deadline: 1 week prior to program

TRIP FOR FALL OF 2013

Day: Monday Time: 5:30-8:30pm Location: Hays Recreation Center Fee (R/NR): $22/$33 Min/Max: 4/10 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Louisville Kentucky
Do you like baseball, horses and adventure? If so start saving now for our trip to Louisville Kentucky for fall of 2013. There we will be visiting the Kentucky Derby Museum, Louisville Slugger Museum, and the Louisville Mega Cavern were we will be taking a tour of the underground caves and zip lining. Look forward to more information in our upcoming brochures!

3 Nights/ 4 Days in

Jumpin at Jupiters
Ages 18+
Have you and your friends been looking for a night where you can play some pool, enjoy arcade games, and win some prizes? If you have, meet us at Jupiters at the Crossing for a night of that and much more. CUSR will pay for one game of pool. Please bring money for food and arcade games. GOALS: To increase money management skills, and enhance social skills with peers and community members. Date September 17 October 8 November 19 December 10 Program ID 242524-A1 242524-A2 242524-A3 242524-A4 Transportation ID 242524-T1 242524-T2 242524-T3 242524-T4

Adults ~ Wednesday

Day: Monday Time: 7-9pm Location: Meet at Jupiters at the Crossing Fee (R/NR): $17/$25.50 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Hays Hangout
Ages 18+
Fill the evening with a night of cards, Wii, board games and more. At Hays Hangout you will do just that and socialize with all of your friends from CUSR. Snacks are included. GOALS: To enhance socialization with peers and turn taking skills. Date September 24 October 22 November 26 December 17 Program ID 222505-A1 222505-A2 222505-A3 222505-A4 Transportation ID 222505-T1 222505-T2 222505-T3 222505-T4

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 of course meet new friends. Admission is included; you just need to bring your dancing shoes! GOALS: To enhance socialization with peers and meet new people. Date September 5 October 3 November 7 December 5 Program ID 243003-A1 243003-A2 243003-A3 243003-A4 Transportation ID 243003-T1 243003-T2 243003-T3 243003-T4

Day: Monday Time: 6:30-8pm Location: Hays Recreation Center Fee (R/NR): $7/$10.50 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Day: Wednesday Time: 5:15-9:15pm Location: Meet at Hays Recreation Center Fee (R/NR): $13/$19.50 Min/Max: 6/24 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

www.cuspecialrecreation.com

Adults ~ Wednesday
Martial Arts
Ages 16-35

Adults ~ Thursday
Diners Club
Ages 18+
Join us as we go out to different restaurants around town for dinner. CUSR will be picking up your dinner tab! At Diners Club you will be able to socialize with your friends and enjoy a GREAT dinner. GOALS: To enhance socialization with peers, increase money management skills, and dining etiquette. Date September 6 October 4 November 1 December 6 Restaurant Old Chicago Oishi Monicals (Mattis) Ruby Tuesdays Program ID 242504-A1 242504-A2 242504-A3 242504-A4

(formerly Taekwondo)
Come experience the art of Taekwondo and gain overall exposure to the martial arts. CUSR has partnered with Tina and Jeff Newberry of Leaders for Life/ Newberrys 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. The fee does not include a uniform. The cost for a uniform is $45 payable to Leaders for Life Martial Arts. Uniform sizes will be determined at the first class and you will receive your uniform at the second class. Promotion tests (at an additional cost) are optional, but recommended. 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 Newberry GOALS: To increase concentration and balance, and improve coordination, gross motor skills, endurance, flexibility, and balance. It will also focus on self-confidence and self-defense. Date September 12December 26 Day Wednesday Program ID 232806-A1

Day: Thursday Time: 6-7:30pm Location: Meet at restaurant Fee (R/NR): $100/$150 for all four venues $41/$61.50 for each individual venue Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10 each; $40 all four Transportation ID: 242504-T1; T2; T3; T4

Healthy Snacking
Ages 18+
Join us as we learn and prepare healthy snacks. We will be working on proper proportions, balanced snack choices, and of course enjoying our creations. If you are looking for a healthier alternative when it comes to snacking, this program is perfect for you! GOALS: To develop appropriate dining etiquette, improve cooking skills, and improve awareness of nutritional decisions. Date September 13 October 11 November 8 December 13 Program ID 243404-A1 243404-A2 243404-A3 243404-A4 Transportation ID 243404-T1 243404-T2 243404-T3 243404-T4

Time: 6-6:45pm Location: Stephens Family YMCA, 2501 Fields South Drive, Champaign located off Windsor Rd, over the bridge at I-57. Classroom 118. Fee (R/NR): $161/$241.50 Min/Max: 4/12 Deadline: September 7

Scholarships & Payment Plans Available

Day: Thursday Time: 4:30-6pm Location: Hays Recreation Center Fee (R/NR): $8/$12 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Adults ~ Friday
Blackout B-I-N-G-O
Ages 18+
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: To enhance socialization with peers and turn-taking skills. Date September 27 October 25 November 29 December 20 Program ID 232501-A1 232501-A2 232501-A3 232501-A4 Transportation ID 232501-T1 232501-T2 232501-T3 232501-T4

Movie Night
Ages 18+
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, you just need to be ready for some entertainment! GOALS: To enhance socialization with peers, increase listening and comprehension skills. Date September 7 October 5 November 2 December 7 Program ID 242503-A1 242503-A2 242503-A3 242503-A4 Transportation ID 242503-T1 242503-T2 242503-T3 242503-T4

Day: Thursday Time: 6:30-7:30pm Location: Hays Recreation Center Fee (R/NR): $11/$16.50 Min/Max: 6/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Day: Friday Time: 6:30-8:30pm Location: Hays Recreation Center Fee (R/NR): $7/$10.50 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Karaoke and Dancing

Ages 18+
ATTENTION all singers and dancers. Come on over as CUSR brings out the karaoke machine for a night of dancing and singing. With lots of music to choose from, its sure going to be a good time. Snacks will be provided. GOALS: To increase socialization skills and turn-taking skills. Date Program ID Transportation ID October 12 242518-A1 242518-T1 November 16 242518-A2 242518-T2 Day: Friday Time: 6:30-8pm Location: Hays Recreation Center Fee (R/NR): $7/$10.50 Min/Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

www.cuspecialrecreation.com

Adults Day Programs

Too Fit to Quit
Ages High School Graduate-35
Looking for something to do during the day? Why not spend the early afternoon with your friends from CUSR and work out! At our fitness class we will explore yoga, stretching, strength training, endurance and much more. GOALS: To increase gross motor skills, gain knowledge of proper fitness techniques, and improve overall physical fitness. Date September 4December 20 Time 10:30-11:30am Program ID 243401-A1

Out and About

Ages High School Graduate-35

Join CUSR as we take a day trip once a month to places near and far. Any admissions and meals are included in the fee. GOALS: To increase socialization among peers, increase money management skills, and enhance community awareness. Date September 14 October 12 November 16 December 7 Location Decatur Zoo and Lunch The Great Pumpkin Patch Cook the Day Away Scrapbook Sensations Program ID 243403-A1 243403-A2 243403-A3 243403-A4

Days: Tuesdays/Thursdays Location: Spalding Recreation Center Fee (R/NR): $50/$75 for all sessions Min/Max: 6/15 Deadline: One week prior to program

Session 1: Decatur Zoo and Lunch Day: Friday Time: 9am-2pm Location: Meet at the Hays Recreation Center Fee (R/NR): $32/$48 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10 Transportation ID: 243403-T1 Session 2: The Great Pumpkin Patch in Arcola Day: Friday Time: 12:30-4pm Location: Meet at the Hays Recreation Center Fee (R/NR): $13/$19.50 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10 Transportation ID: 243403-T2 Session 3: Cook the Day Away Day: Friday Time: 2-4pm Location: Meet at the Hays Recreation Center Fee (R/NR): $21/$31.50 Min/Max: 6/12 Deadline: 2 week prior to program Door-to-Door Transportation Fee: $10 Transportation ID: 243403-T3 Session 4: Scrapbook Sensations Day: Friday Time: 2-4pm Location: Meet at the Hays Recreation Center Fee (R/NR): $8/$12 Min/Max: 6/12 Deadline: 2 week prior to program Door-to-Door Transportation Fee: $10 Transportation ID: 243403-T4

Luncheon Bunch

Ages High School Graduate-35

Whats for lunch today? Join us as we head out and experience different restaurants around town. CUSR will pick up your tab for lunch, you just have to join the club! GOALS: To increase money management and dining etiquette skills, and increase socialization among peers. Date September 5 September 19 October 3 October 17 November 7 November 21 December 5 December 19 Location Pancheros El Toro (Springfield) Monicals OCharleys Zas (Springfield) Taffies Old Chicago Groups Choice Program ID 243402-A1 243402-A2 243402-A3 243402-A4 243402-A5 243402-A6 243402-A7 243402-A8

Day: Wednesday Time: 11:30am-1pm Location: Meet at the restaurant Fee (R/NR): $35/$52.50 monthly or $135/$202.50 for all 8 sessions Min/Max: 6/12 Deadline: One week prior to program

10

September Special Events

Fighting Illini Bass Fishing Clinic
Ages 13+
Come cast away with the University of Illinois Bass Fishing Club! Club members will instruct you on how to cast and other fishing techniques while we try to catch some fish at Crystal Lake. This program is sponsored by the Fighting Illini Bass Fishing Club and will be staffed by club members. CUSR staff will be in attendance for program supervision. Note: This is a catch and release program. All fish will be released back into Crystal Lake. Due to the clubs other commitments, the exact date of the program will not be known when the brochure is printed. Please contact the CUSR office in August for more information. GOALS: To increase hand-eye coordination and exposure to a new leisure activity. Date TBD Time Program ID 4:30-6:30pm 232901-A1

Sports Club
Ages 18+
ATTENTION SPORT FANS! CUSR has the perfect club for you! We will be attending two sporting events this summer. Cost of your ticket is included. You will need to bring money for snacks. GOALS: To increase socialization and money management skills. Date November 20 TBA Location and Program Parkland Womens Basketball Parkland Womens Volleyball

Session 1: Parkland Womens Basketball Day: Tuesday Time: 4:45-7:45pm Location: Meet at Hays Recreation Center Fee (R/NR): $19/$28.50 Min/Max: 6/12 Deadline: 1 week prior to program Program ID: 242807-A1 Door-to-Door Transportation Fee: $10 Transportation ID: 242807-T1 Session 2: Parkland Womens Volleyball Day: TBA Time: TBA Location: Meet at Hays Recreation Center Fee (R/NR): $19/$28.50 Min/Max: 6/12 Program ID: 242807-A2 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10 Transportation ID: 242807-T2

Day: Friday Location: Crystal Lake Park Fishing Dock Fee (R/NR): Free! *All participants attending must register. Min/Max: 8/20 Deadline: Thursday before program

Chili and Bingo Night in Decatur

Ages 18+
Join us as we travel to Decatur to visit with our friends as we play BINGO and eat some delicious chili. There will be some great BINGO prizes! GOALS: To enhance socialization with peers and make new friends. Date Program ID Transportation ID September 21 243022-A1 243022-T1 Day: Friday Time: 5-9pm Location: Meet at Hays Recreation Center Fee (R/NR): $27/$40.50 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

www.cuspecialrecreation.com

11

September Special Events

Curtis Orchard and Lunch
Ages 18+
Join us as we spend the afternoon at Curtis Orchard to pick apples and shop. We will then eat lunch at the caf located at the apple orchard. CUSR will be picking up your tab for lunch. Please bring money for Curtis Orchard. GOALS: To enhance socialization with peers, increase money management skills and dining etiquette. Date Program ID September 23 242530-A1 Transportation ID 242530-T1

October Special Events

Conklins Barn II Dinner Theatre
Ages 21+
Move Over, Mrs. Markham is the play we will be heading to see in Goodfield, Illinois. There you will enjoy a wonderful buffet dinner followed by the play. Cost of meal and play included. GOALS: To enhance socialization with peers and gain cultural experience. Date October 14 Program ID 243013-A1 Transportation ID 243013-T1

Day: Sunday Time: 10:45am-1:15pm Location: Meet at the Hays Recreation Center Fee (R/NR): $25/$37.50 Min/ Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Day: Sunday Time: 10:30am-5pm Location: Meet at Hays Recreation Center Fee (R/NR): $60/ $90 Min/Max: 6/12 Deadline: 2 weeks prior to program Door-to-Door Transportation Fee: $10

Apple and Pork Festival

Ages 18+
Join us as we venture out to Clinton, Illinois for their annual Apple and Pork Festival. There we will look at all of the booths and see what the vendors have to offer. Please bring money for your lunch and souvenirs. **Must be able to walk long distances GOALS: To increase money management skills and social skills within the community. Date Program ID September 29 243017-A1 Transportation ID 243017-T1

Halloween Party
Ages 18+
Ghosts, goblins, and more! Come on out to CUSRs annual Halloween Party. We will be playing games, enjoying a tasty snack, dancing, and having a costume contest, so wear your best costumes! GOALS: To enhance socialization skills with peers. Date October 31 Program ID 272504-A1 Transportation ID 272504-T1

Day: Saturday Time: 9am-2pm Location: Hays Recreation Center Fee (R/NR): $37/$55.50 Min/Max: 6/12 Deadline: One week prior to program Door-to-Door Transportation Fee: $10

Day: Wednesday Time: 6-8pm Location: Hays Recreation Center Fee (R/NR): $16/$24 Min/Max: 6/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

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Find us on Facebook and stay connected Champaign-Urbana Special Recreation

November Special Events

Holiday Shopping and Lunch at Orland Park Mall
Ages 18+
Do you have too much holiday shopping and not enough time to get it all in? Put your worries aside and spend the afternoon shopping with your friends from CUSR. We will be heading out to Orland Square Mall to shop and look at all of the holiday decorations. CUSR will pick up your tab for lunch; you just have to bring your shopping list and money for gifts. GOALS: To enhance decision making skills. Improve budgetary and money management skills. Date November 10 Program ID 242901-A1 Transportation ID 242901-T1

Dinner and Cosmic Bowling

Ages 18+
Looking for things to fill your Saturday nights? CUSR staff will choose the restaurant based on some local favorites and then head to Arrowhead Lanes for Cosmic Bowling. CUSR will pay for your dinner and two games of bowling. *NOTE: STROBE LIGHTS MAY CAUSE SEIZURE ACTIVITY GOALS: To improve gross motor coordination, turn-taking skills, and socialization with peers. Date Program ID Transportation ID November 17 242527-A1 242527-T1 Day: Saturday Time: 7-11pm Location: Meet at Hays Recreation Center Fee (R/NR): $39/ $58.50 Min/Max: 4/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Day: Saturday Time: 8am-4pm Location: Meet at the Hays Recreation Center Fee (R/NR): $35/$52.50 Min/Max: 6/12 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

www.cuspecialrecreation.com

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December Special Events

Winter Wonderland Ball
Ages 18+
Walking in a Winter Wonderlandjoin us as we celebrate the holidays at our Winter Wonderland Ball. Dinner will be served and the dance floor will be open. GOAL: To enhance socialization with peers. Date December 1 Program ID 242902-A1 Transportation ID 242902-T1

Adult Trips
St. Louis Overnight
Ages 21+
On our St. Louis overnight we will be visiting the St. Louis Science Museum and gambling at the Queens Casino. Lodging, meals and admission is included. Please bring money for souveniers. NOTE: Must be an adult 21 or over to attend and bring a state issued photo I.D. GOALS: To enhance decision making skills, and improve budgetary and money management skills. Date October 6-7 Program ID 243023-A1

Day: Saturday Time: 6-9pm Location: Hays Recreation Center Fee (R/NR): $25/$37.50 Min/ Max: 4/25 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Day: Saturday-Sunday Time: Leaving the Hays Center at 9am on October 6. Returning at noon on October 7. Location: Meets at the Hays Recreation Center Fee (R/NR): $185/ $277.50 Min/Max: 6/10 Deadline: 9/5

Pottery Place
Ages 18+
Paint the evening away with your friends from CUSR as we head out to Pottery Place. CUSR will pay for your paint, studio time, and one piece of pottery. Just bring your creativity! GOALS: To increase artistic expression and social skills. Date Program ID Transportation ID December 14 242525-A1 242525-T1 Day: Friday Time: 6:30-8pm Location: Meet at Pottery Place Fee (R/NR): $32/$48 Min/Max: 6/24 Deadline: 1 week prior to program Door-to-Door Transportation Fee: $10

Timber Pointe Overnight

Ages 16-35
Were headed back to Timber Pointe Outdoor Center! This falls trip will be a one-night cabin camping trip with nature activities, arts & crafts, cooking, a campfire, and more! Were happy to announce that this year we have increased our maximum number of participants for this trip to ensure that everyone is able to attend. Note: Please communicate any dietary restrictions and additional special needs information to Hannah upon registering for this program. GOALS: Increase self confidence, improve ability to interact with others and increase nature appreciation. Date November 3-4 Program ID 243021-A1

Day & Time: Saturday 9:30am-Sunday 11:30am Location: Meet at Hays Center Fee (R/NR): $89/$133.50 Min/Max: 6/15 Deadline: October 22

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Special Olympics
Special Olympics Illinois provides year around 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 * Volleyball * Power Lifting * Basketball * Basketball Skills * Bocce * Track & Field * Softball * Bowling

Mustang Basketball
Ages 13+
Mustang team basketball practice will begin on November 6. Registration and a valid Special Olympics Medical Application must be on file at the CUSR office by November 6th for all male basketball athletes. Teams will play a minimum of three games before the Special Olympics district competition in January. Any teams that qualify for the Special Olympics state tournament will continue practicing after January 15. GOALS: To increase overall physical fitness, gain knowledge of individual basketball skills and team strategy, and improve team cooperation skills. Date Time Program ID November 6-January 15* 6-7:30pm 222815-A1 *No program December 25 and January 1 Day: Tuesday Location: Brookens Gym Fee (R/NR): $59/$88.50 Min/Max: 7/20 Deadline: November 13 Door-to-Door Transportation Fee: $110 Transportation ID: 222815-T1

Important Special Olympic Dates

September 8-9 September 15 October 13 October 27-28 December 1 December 29 State Softball Tournament, Decatur Volleyball Qualifier, LaSalle Sectional Bowling, Peoria Fall Games, Rockford State Bowling, Peoria Holiday Classic, Bloomington

Criteria for Participation

All 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 Physician) Applications 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: Hannah Sheets, CUSR Athletics Coordinator at 217-239-1152.

Lady Mustang Basketball

Ages 13+
Lady Mustang team basketball practice will begin on December 4. Registration and a valid Special Olympics Medical Application must be on file at the CUSR office by December 4th for all female basketball athletes. Teams will play a minimum of three games before Special Olympic competition in March. GOALS: To increase overall physical fitness, gain knowledge of individual basketball skills and team strategy, and improve team cooperation skills. Date Time Program ID December 4-March 17* 6-7:30pm 232808-A1 *No program December 25 and January 1 Day: Tuesday Location: Brookens Gym Fee (R/NR): $59/$88.50 Min/Max: 7/15 Deadline: December 11 Door-to-Door Transportation Fee: $110 Transportation ID: 232808-T1

www.cuspecialrecreation.com

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Athletics
Aquafun & Fitness
Ages 15+ New!
Splish-splash were gettin fit in a flash! At Aquafun & Fitness well use foam water weights and noodles to get a great workout in the warm water therapy pool. Come try CUSRs first water exercise class. The warm water will feel so good, you wont even know youre getting a workout! GOALS: To increase gross motor coordination and strength, and improve balance and mobility. Date September 10-October 22 October 29-December 17 *No program November 12 Day: Monday Time: 5:45-6:30pm Location: Stephens Family YMCA Fee (R/NR): $47/$70.50 Min/Max: 4/8 Deadline: September 3 Sign up for both sessions for $90/$135! Program ID 232810-A1 232810-A2

Martial Arts
Ages 16-35

(formerly Taekwondo)
Come experience the art of Taekwondo and gain overall exposure to the martial arts. CUSR has partnered with Tina and Jeff Newberry of Leaders for Life/Newberrys 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. The fee does not include a uniform. The cost for a uniform is $45 payable to Leaders for Life Martial Arts. Uniform sizes will be determined at the first class and you will receive your uniform at the second class. Promotion tests (at an additional cost) are optional, but recommended. 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 Newberry GOALS: To increase concentration and balance, and improve coordination, gross motor skills, endurance, flexibility, and balance. It will also focus on selfconfidence and self-defense. Date September 12December 26 Day Wednesday Program ID 232806-A1

Swim Lessons

Thanks to our cooperative program agreement, swim lessons are now held at the Stephens Family YMCA. Please check out their brochure or call 217-359-9622 for more information.

Time: 6-6:45pm Location: Stephens Family YMCA, 2501 Fields South Drive, Champaign located off Windsor Rd, over the bridge at I-57. Classroom 118. Fee (R/NR): $161/$241.50 Min/Max: 4/12 Deadline: September 7

Scholarships & Payment Plans Available

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Frunner Club
Ages 15+
Returning and new runners of all paces are welcome for our fall session of Frunner Club. Training partners will work with you at your own pace. Enjoy the fall weather and get some exercise by training for a 5K race in November. Please wear shoes with proper support and weather appropriate clothing. *Please note that the fall frunner days have changed to Sundays and Thursdays this year. GOALS: To improve cardiovascular fitness and ability to interact with others, and increase self confidence. Date September 13-November 18 Program ID 242805-A1

Ages 13-21

Teen Pins

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. Note: Participants arriving late will bowl 2 games or as long as time allows. GOALS: To improve social skills and ability to interact with others, learn and practice bowling etiquette, and increase gross motor coordination. Date September 17-December 3 September 19-December 5 Day Program ID Mon. 232605-A1 Wed. 232605-A2

Day & Time: Sunday: 4-5pm; Thursday: 5:30-6:30pm Location: Sunday: Dexter Field parking lot Thursday: Pavilion at Hessel Park Fee (R/NR): $51/$76.50 Min/Max: 4/10 Deadline: September 7

*No program November 12 and November 21 Time: 4-5pm Location: Western Bowl Fee (R/NR): $76/$114 Min/Max: 4/25 Deadline: September 24 Home-Only Transportation Fee: $65 Transportation ID: 232605-T1; 232605-T2

Strikes & Spares

Ages 21+
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. Note: Participants arriving late will bowl 2 games or as long as time allows. GOALS: To improve social skills and ability to interact with others, learn and practice bowling etiquette, and increase gross motor coordination. Date September 17-December 3 September 19-December 5 Day Program ID Mon. 222802-A1 Wed. 222802-A2

*No program November 12 and November 21 Time: 4-5pm Location: Western Bowl Fee (R/NR): $76/$114 Min/Max: 4/25 Deadline: September 24 Home-Only Transportation Fee: $65 Transportation ID: 222802-T1; 222802-T2

www.cuspecialrecreation.com

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Athletics
Fitness Frenzy
Ages 15+
Need some extra motivation to get fit? Try exercising with a friend! Participants will be paired with a CUSR staff who will exercise with them for an 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 Hannah Sheets. GOALS: To increase gross motor coordination and physical fitness, and gain knowledge of proper fitness techniques. Date October 8-December 9 Location: TBD Fee (R/NR): $213/$319.50 Deadline: September 21 Program ID 232809-A1

Thank You to Our Support Staff!

Anna Fairbairn Kasey Boeger Ricky Waller Allie Lindeman Erica Volkmann Emma Hurley Lynnsey Brownfield Aimee Puls Gabby Fairbairn Allie Lindemann Chris Hayek Stephanie Reiss Amanda Mergenthaler Sara Anderson Chris Billings Brittany Davidson Ashley Robertson Brandy Ross Taylor Wernsing Shelbie Kearfott Jessica McKinnon Jack Moser Tara Robertson Terrenia Kent Miranda Terry Anne Shea Anne McNamara Nandi Tense Roxanne Baker Yvonne Fisher Courtney Brokamp Chelsea Hart Rachael Higgins Catherine Wilkie Tricia Lauter Taylor Bates Gary Zimmerman Justin Green Ashley Bordeaux Taiesha Stroud Kaitlyn McKinnon Alex Anderson Ariana Dymerski Aramis Kent Kaley Barak Hannah Jacobs Molly Thinnes Sarah Moe Mara Hampton Lisa Stiverson Sarah Prendergast Ashley Souk Shalonda Pelmore Natasha Nuss Donald James Brian Boles Mary ORouke Katelyn Myracle Elizabeth Hult Emma Gibbens Shelbie Sumner Leeann Smith Alyssa Wright Katherine Connor Emily Gelber Janet Slater Kimberly Litchfield

*No program week of November 19-25

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ALL INFORMATION BELOW MUST BE COMPLETED FOR FORM TO BE PROCESSED. ANY FORM NOT COMPLETELY FILLED OUT WILL BE RETURNED TO PARTICIPANT.

MAIL FAX

CUSR 1311 W. Church St., Champaign, IL 61821 217-373-7951 QUESTIONS: (phone) 217-239-1152 711 Relay

PARTICIPANT NAME ADDRESS PHONE (H) PHONE (W) CITY BIRTHDATE PRIMARY DISABILITY PROGRAM NAME 1. 2. 3. 4. 5. Would you like to make a donation to the CUSR scholarship fund? Fee Waiver/Scholarship applied for? ________ NO $5.00 $10.00 Other CODE PICK UP POINT TRANSPORT CODE FEE AGE ZIP SEX SHIRT SIZE

________ YES (If yes, please attach)

PARENT/GUARDIAN EMERGENCY NAME DOCTORS NAME PREFERRED HOSPITAL

PHONE (H) PHONE (H) PHONE

PHONE (C) PHONE (C)

CUSR may use pictures and videos taken at programs for publicity purposes. Is this okay? List Medications: List Allergies: List Dietary Restrictions: List Special Needs/Assistance Necessary: Please circle all that apply: Wheelchair: manual/electric Seizures Cane/Walker Nonverbal Sign Lanuage

__________ Yes

__________ No

Close Supervision

Atlantoaxial Subluxation Condition

See back of form for credit card payment information

Participants name Participants signature*
(18 YEARS/OLDER OR PARENT/GUARDIAN)

Date*

* Participation can be denied if the signature of adult participant or parent/guardian and date are not on this waiver. Please call 239-1152, if you require special accommodations.

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 participants 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, inadequate 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 programs/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.

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) Authorized Signature Expiration Date Charge Amount

APPLICATION FOR PARTICIPATION IN SPECIAL OLYMPICS ILLINOIS

Valid Application for Participation is mandatory for all competitors 605 E. Willow St. Normal, IL 61761-2682 309-888-2551
SO ILL OFFICE ONLY
Y

SO ILL Rev. 8-1-10

Birthdate M M D D Y

Athlete Name (last name, space, first name)

ATHLETE INFORMATION

MEDICAL CLEARANCE
PLEASE CHECK MEDICAL INFORMATION

Agency Name Sex (M or F)

Athletes Mailing Address

Parents/Guardians (Please Circle One) Home Address

Athletes City

Parents/Guardians City

Does athlete have Down Syndrome? Yes No If yes, have x-rays of the C1-C2 vertebrae been taken and examined? Yes No Date of x-ray Is the athlete clear of Atlantoaxial Instability? Yes No

State

Zip Code

State

Zip Code

Asian Parents/Guardians Home Telephone

Ethnicity

White Hispanic/Latino

Black/African American Other

HEALTH INSURANCE & EMERGENCY INFORMATION (Required for Processing)

Emergency Contact Phone ( ) Policy Number

Does the athlete have or is the athlete: Heart Problems Yes Diabetic Yes Epileptic/Seizures Yes Blind Yes Deaf Yes Hepatitis Yes Other Current Medication

No No No No No No Dosage

Person to be contacted in case of emergency

Medical Insurance Company

PARENT AND/OR GUARDIAN AUTHORIZATION AND MEDIA RELEASE

Allergies to medication, if any: Date of last Tetanus shot: I have examined the above-named Entrant and, in my opinion, there is no mental or physical reason why he or she should not participate in the Special Olympics sports training and competition program. Further information will be forwarded if required. Current medication, if any, is specified with dosage on this application. Examination Date Doctors Signature Print Name Address

I, on my own behalf or as the undersigned parent and/or legal guardian of the above named applicant (hereafter referred to as the Entrant), hereby request permission for the Entrant to participate in Special Olympics programs. I acknowledge that Special Olympics will screen all entrants using the Sex Offender Public Registry and the Child Murder and Violent Offender Against Youth Registry and understand that entrants listed on either Registry will be denied participation. I affirm that this Entrant has never been on said Registries or, if Entrant was listed on either Registry but has since been removed, I will contact Special Olympics Illinois for instructions before submitting this application. I represent and warrant to you that the Entrant is physically and mentally able to participate in Special Olympics, and I submit herewith a subscribed medical certificate. I understand that if the athlete has Down Syndrome, he/she cannot participate in sports or events which, by their nature result in hyper-extension, radical flexion or direct pressure on the neck or upper spine unless a full radiological examination establishes the absence of Atlantoaxial Instability. I am aware that the sports and events for which this radiological examination is required are equestrian sports, artistic gymnastics, diving, pentathlon, high jump, alpine skiing, soccer, soccer skills, powerlifting squat and butterfly stroke and diving starts in swimming. On behalf of the Entrant and myself, I acknowledge that the Entrant will be using facilities at his/her own risk and I, on my own behalf, herby release, discharge and indemnify Special Olympics from all liability for injury to person or damage to property of myself and Entrant. In permitting the Entrant to participate, I am specifically granting permission to Special Olympics Illinois to use the likeness, voice and words of the Entrant in television, radio, films, newspapers, magazines and other media, and in any form not heretofore described, for the purpose of advertising or communicating the purposes and activities of Special Olympics and in appealing for funds to support such activities. I understand that by signing below I consent for the Entrant to participate in the Special Olympics Healthy Athletes Program that provides individual screening assessments of health status and health care needs. The Entrant has no obligation to participate and I understand the Entrant should seek his/her own medical advice and assistance and Special Olympics is not responsible for the Entrants health. If I am not personally present at Special Olympics activities in which the Entrant is to compete, so as to be consulted in case of necessity, you are authorized on my behalf and at my account to take such measures and arrange for such medical and hospital treatment as you may deem advisable for the health and well-being of the Entrant. I, THE UNDERSIGNED ADULT ENTRANT, have read and fully understand the I, THE UNDERSIGNED PARENT AND/OR GUARDIAN of the above specified provisions of the above release and/or have had them explained. I hereby agree that I Entrant, have read and fully understand the provisions of the above release and have will be bound thereby and I shall defend Special Olympics Illinois and hold it harmless explained them to said Entrant. I hereby agree that I and said minor will be bound from disaffirmation thereof. thereby, and I shall defend Special Olympics Illinois and hold it harmless from any disaffirmation thereof by said minor.

Entrant Date

Witness

Signature of Parent and/or Legal Guardian (Check appropriate box) Print Name

City
Date

State
Parents Email Address

Zip Phone ( )

Athletes Email Address

Original parent/guardian and doctor signatures are required by the office of Special Olympics Illinois. Faxed signatures will not be accepted.

Instructions for Completing the Application for Participation

The Application for Participation (App) must be filled in completely. Apps with blank sections or attachments (exception: letter 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. Faxed signatures, 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 Registry but has since been removed, contact the Special Olympics Illinois office for instructions before submitting this application.

ATHLETE INFORMATION AND HEALTH INSURANCE & EMERGENCY INFORMATION

1. The first two sections must be filled in completely. The ethnicity information is requested to assist in the organizational outreach efforts.

PARENT AND/OR GUARDIAN AUTHORIZATION AND MEDIA RELEASE

2. 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 emergency telephone numbers from the State Office of Guardianship. As of January 1, 1987, the letter of explanation must be attached.) b. Only one of the two signature blocks must be completed. Special Olympics Illinois works under the understanding that this section 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 athletes signature is unrecognizable (for example, if the athletes signature is an X.)

MEDICAL CLEARANCE
3. The Medical Clearance section must be completed, signed and dated by a medical practitioner licensed to administer physical examinations by the state in which he/she practices. As of September 1, 1990, the Special Olympics Illinois Application for Participation 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 Special Olympics sports training and competition. It is strongly suggested that the person administering the physical examination possess the following: 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 Olympics Illinois Chapter office. The Chapter office will validate the Application for Participation and send a copy of the App with an approved stamp back to the SOAD (Special Olympics Athletic Director). An Application for Participation will not be validated until all 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 established Medical 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 valid throughout the completion of that Chapter competition. Applications for Participation for athletes participating in District Tournaments and Sectional Tournaments must be received before the entry deadline or with registration materials. Applications not on file or in receipt by the specified deadline will not be accepted.

CUSR Information
Program Cancellation Policy
All 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 cancelled 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.

Satisfaction Guaranteed

Inclement Weather Policy

If 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 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 CUSRs 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.

In 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.

Late Pick-Up Policy

Hot temperatures (for outdoor programs) at program time: 100oF actual temperature; heat index of 110oF or more constitutes cancelling program due to unsafe conditions. Cold temperatures (for all programs) at program time: 2oF actual temperature; -30oF or below wind chill constitutes cancelling program due to unsafe conditions.

Extreme Temperature Policy

Program Scholarships

Participant Expectations

Because 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 217239-1152. Payment plans available to all. ALL monies owed must be paid prior to next season registration accepted.

www.cuspecialrecreation.com

1. 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.

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CUSR Information
Discipline
A caring, positive approach will be used regarding discipline. CUSR reserves the right to dismiss participants. Each situation will be evaluated on its own merit.

Transportation Policy/Safety Procedures

1. 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.

Behavior Code

CUSR 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 everyones 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.

Insurance

Individual accident liability insurance is not provided by CUSR.

Dishonored Checks

A $25 service charge will be assessed on all checks returned by the bank for any reason.

Emergency Contacts

Emergency 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 with this is appreciated. Individuals with Downs Syndrome are at risk of having a condition known as Atlanto-Axial Subluxation. CUSR must have a doctors 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.

Atlanto-Axial Subluxation

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CUSR Picture Request

Do you have some great pictures of programs or events? Please email them to cusr@cparkdistrict.com or bring a CD to Hays Recreation Center.

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Program Ideas

Do you want to try out a new food place? Have you wanted to see a play at Krannert? Let us know!

Champaign-Urbana Special Recreation Hays Recreation Center 1311 W. Church St. Champaign, IL 61821

PRSTD. STD. U.S. Postage PA I D Permit No. 287 Champaign, IL

www.cuspecialrecreation.com cusr@cparkdistrict.com
1500

Design-A-Program
CUSR is always looking for new ideas for programs. Perhaps you have an interest in something special and would like to see if we can offer it. Please fill in this form and return it to: Champaign-Urbana Special Recreation, 1311 W. Church Street, Champaign, IL 61820. As a bonus, if a program you suggest becomes a reality, you will be given the opportunity to attend that program FREE OF CHARGE for one season! In the case of duplicate suggestions, names will be drawn to determine who receives the free program. Name Address City

Zip

Phone

I would like to see the following program(s) offered: