Accommodation Requests

Name*

First Last

Parent or Guardian Name (if under 18)

Phone*

Email*

Participation activity or activities that you would like to participate in (check all the apply):*

If you selected "other," please explain.*

Location*

Date Requested*

Time Requested*

:

Duration of Activities*

If you require accommodations in order to participate, please contact MartyD@recsports.ufl.edu. Please identify barriers that may impact your time at the Rec Center below:*

Please check if you will be bringing a Personal Care Attendant with you.

Yes. I will be bringing a care attendant with me.

Please rate how you feel about using the RecSports facilities and programs. These activities can include accessing and exiting the facilities, participation in programs, and participation in cardio and weight equipment.*

5. Completely comfortable using without accommodation support.
4. Could utilize fairly effectively without accommodation support.
3. Could utilize, but not as effectively as I could with accommodation support.
2. Could utilize few areas without accommodation support.
1. Could not utilize without accommodation support.

Do you have any additional requests?

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