1b. 2009 REACH for Resources Adaptive Recreation Contract
CITY OF
CHANHASSEN
7700 Market Boulevard
PO Box 147
Chanhassen, MN 55317
Administration
Phone: 952.227.1100
Fax: 952.227.1110
Building_Inspections
Phone: 952.227. 1180
Fax: 952.227.1190
Engineering
Phone: 952.227.1160
Fax: 952.227.1170
Finance
Phone: 952.227.1140
Fax: 952.227.1110
Park & Recreation
Phone: 952.227.1120
Fax: 952.227.1110
Recreation Center
2310 Coulter Boulevard
Phone: 952.227.1400
Fax: 952.227.1404
Planning &
Natural Resources
Phone: 952.227.1130
Fax: 952.227.1110
Public Works
1591 Park Road
Phone: 952.227.1300
Fax: 952.227.1310
Senior Center
Phone: 952.227.1125
Fax: 952.227.1110
Web Site
www.ci.chanhassen.mn.us
1-b
---
FROM:
DATE:
SUBJ:
2009 REACH for Resources Adaptive Recreation Contract
PROPOSED MOTION:
"The City Council approves the REACH for Resources Adaptive
Recreation contract for 2009 in the amount of $6,882.27."
Approval of this contract requires a simple majority vote of those City
Council members present.
On an annual basis, the City of Chanhassen reviews its contract with REACH
for Resources to provide adaptive recreation services. Chanhassen is part of a
consortium of cities in the west metro that contract for these services. The city
has been contracting with REACH fofResources since 1999 and staff is very
satisfied with the service they provide.
Last summer, REACH staff trained our playground staff on how to address or
accommodate a person with disabilities, provided guidelines for effectively
working with families, and techniques and tips to integrate all participants.
REACH staff did an awesome job and provides this training every year. I
have had conversations with parents who are thrilled that these special
inclusion services are available for their children and that they are able to
participate in activities with their siblings and friends. I have seen first hand
that we are making a difference in the lives of these children.
The 2009 contract amount reflects an increase over 2008. This is a direct
result of increased participation from 12 to 48 participants. Each of the five
cities in the consortium is charged based on participation levels from their
community. Chanhassen's share of the contract increased from 3% to 9%
becall;se of the increase in participation. The city is charged a base price of
$2,500 for adaptive recreation services, plus the 9% share ($4,382.27), which
calculates to a total contract amount of $6,882.27 for 2009.
G:\P ARK\JERR Y\reachcontractmemo2009 .doc
Chanhassen is a Community for life - Providing for Today and Planning for Tomorrow
Mr. Todd Hoffman
February 24,2009
Page 2
RECOMMENDATION
Staff recommends that the Park & Recreation Commission recommend that
the City Council approve the 2009 contract for adaptive recreation services
with REACH for Resources.
STAFF UPDATE (2-27-09)
The Park & Recreation Commission reviewed the REACH for Resources
contract at their February 24,2009 meeting. After review, the commission
unanimously recommended that the City Council approve the 2009 REACH
for Resources Adaptive Recreation contract in the amount of$6,882.27.
ATTACHMENT
1. 2009 REACH for Resources Adaptive Recreation Contract.
2007 WARC PARTICIPATION TOTALS
Regular
Program Special
City % Winter Sprin2 Summer Fall Inclusions Total Events TOTAL
Chanhassen 9% 2 8 13 11 4 38 10 48
Chaska 5% 0 5 4 3 9 21 40 61
Hopkins 19% 17 24 21 18 0 80 26 106
Minnetonka 37% 42 33 45 26 6 152 60 212
St. Louis Park 30% 24 33 41 25 1 124 89 213
TOTAL 100% 85 103 124 83 20 415 225 640
PROPOSED BUDGET 2009
City % Base % Chanl!e TOTAL
Chanhassen 9% $2,500.00 $4,382.27 $6,882.27
Chaska 5% $2,500.00 $2,434.59 $4,934.59
Hopkins 19% $2,500.00 $9,251.45 $11,751.45
Minnetonka 37% $2,500.00 $18,015.98 $20,515.98
St. Louis Park 30% $2,500.00 $14,607.55 $17,107.55
TOTAL 100% $12,500.00 $48,691.84 $61,191.84
G:\P ARK\JERR Y\reachcontractmemo2009 .doc
Contract Af!reement
WHEREAS, The city of Chanhassen (hereinafter called the "city") is in
agreement for Reach For Resources, Inc. (hereinafter
called the "contractor") to provide adaptive recreation services for
children and adults with developmental disabilities.
WHEREAS, Reach For Resources, Inc. and the four Western
Communities did contend that a part-time professional will coordinate
programs for persons who have developmental disabilities.
WHEREAS, The city desires that Reach For Resources, Inc. provide
such a coordinator:
1. The contractor shall perform all the services of this agreement,
as described in the proposal.
2. The payment shall be $6,882.27
3. The method of payment shall be:
$6,882.27 Annually
Quarterly
Other
Semi-Annually
Monthly
4. This agreement shall be in force and effect for a period of one-
year commencing on January 1, 2009.
Reach For Resources, Inc.
City of Chanhassen
BY~~
By
Title~~~~
Title
Therapeutic Recreation Service Agreement
Reach For Resources, Inc. contracts with a consortium of Northwestern municipalities to
provide for the on-going development of therapeutic/adaptive recreation services for
people with developmental disabilities and their families. The services shall include the
provision of a Director of Therapeutic Recreation who will be responsible for:
· Planning and design of a series of community-based quarterly recreational
program offerings for children, teens, and adults with disabilities.
· Implementation of all aspects of these programs including: activity development,
scheduling, hiring, training and supervision of program leaders, and on-going
monitoring and direction of programs.
· Follow-up and evaluation of programs with key stakeholders.
· Submission of 9uarterly reports to city personnel.
· Consultation, training, information and referral to parents, professional or other
community/public organizations.
· Collaborations with city, school, or other groups to provide joint program
offerings.
· Participation and input into community committees.
· Individual leisure planning and development.
Individual cities may also purchase:
· Community inclusion services into general park and recreation programs. These
services' include individual assessment, adaptation recommendations,
consultation with recreation generalists and provision of aides including their
recruitment, training and supervision.
Program offerings shall include programs such as:
· Adult social clubs for various levels of disability.
· Adult athletic leagues.
· Teen social chibs.
· Teen athletic leagues.
· Children's social clubs.
· Special events.
· Holiday parties/dances.
Recreational programs shall have overall Reach support which includes consultation as
needed with other Reach professionals to assist in the development of individual
behavioral plans or support for other programming decisions or issues as they arise.
Service professionals currently available to assist the recreation director include:
· A licensed psychologist.
· A licensed social worker.
· A special education teacher.
· A community skills trainer and client advocate.
REACH Self-Advocates had a busy fall prepar-
ing to exercise their rights as citizens in the
November election. They began by participat-
ing in a two-part Voter Education course offered
by REACH in October. The course helped them
identify issues that are important to them, learn
the ins and outs of voting, identify their voting
districts, and develop questions to askwhen
evaluating candidates.
Instructor Jay-C Santiago-Alverez was very
proud of the self-advocates who enrolled. "The
group had a lot of energy and we had some
great discussions about issues," she says. Partici-
pant John Wolfe, who has concerns Qbout
supportive employment availability said he
learned a lot from the course and hoped that a
lot more people would get out and vote this
year.
Participants also attended the Third Congres-
sional District Forum on October 16th to meet
candidates Ashwin Madia and David DiDon and
learn about their stances on issues such as ADA
enforcement, Medicaid, transportation,
employment and housing supports for people
with disabilities.
All of the participants reported they were
more confident about voting and planned to
vote in the general election on November 4th.
Ashwln Madia. DFL
candidate tor the U.S.
House of Representa-
tives, chats wNh Laura
Cooper and REACH
Executive Director. Mary
Perklns.
Katie Mann, Robert Topp, Laura Cooper, Sandra Llndel and John
WoNe attend a "Meet the Candidates" session In Mlnnetonka
hosted by the Minnesota Consortium for Citizens wNh Disabidies.
Tom Carey meets David Dilon, Independence Party
candidate for the U.S. House of Representatives.
REACH met with representatives from Metro Mobility in August
to gather information about changes to the certification rules.
Here are answers to some of your important questions.
Why did Met Council chanae the eliaibilitv rules? A federal
audit was conducted and found that the system in the Twin
Cities had generous eligibHity rules that went beyond the re-
quirements of the American's with Disabilities Act. In addition,
there have been some abuses of the service by people who
do not really need it. Met Council was required by the federal
audit to bring the service in line with the narrower ADA require-
ments or lose federal transportation funding.
Does evervone who is currentlv certified have to be re-
certified? Yes - but not unto your current certification expires.
Who will now be eliaible for Metro Mobilitv? Under the new
guidelines you wi. be eligible for Metro Mobility if:
. It is impossible for you to take regular public transportation
due to a physical disability, such as using a wheelchair.
OR
. You are unable to navigate the bus system once you are
on a route due to cognitive or physical impairments. This
includes things like being unable to read schedules, recog-
nize your stop, recognize landmarks, askfor help if you get
lost, or know what to do if your bus route is detoured.
OR
. You are unable to walkor ambulate % of a mile or 9 blocks
to and from a bus stop due to physical or cognitive impair-
ments.
There are no fixed bus routes between mv house and mv iob.
Does that make me eliaible? NO. A lack of fixed or conven-
ient bus routes alone is not enough to qualify you for Metro
Mobility under the new rules. To qualify you will have to prove
that your disability prevents you from using any regular bus
route.
What is involved in the recertification Drocess? You wHl have to
complete an application and provide signed verifications from
professionals who can attest that your disability prevents you
from taking the public bus. Metro Mobility urges people to sub-
mit as many professional verifications as possible. These can
be from physicians, social workers, psychologists, etc. On your
application you should also list every possible disability-related
issue that may keep you from riding the bus. Under the new
rules. it is UD to yOU to Drove that you cannot use the reaular
bus system or learn to use it due to your disability. REACH staff
are available to help you fill out your application and gather
the necessary documentation.
After your application is reviewed you may be approved or
you may be asked to complete an in-person assessment and/
or work with a travel trainer to determine how weB you can
function on the public bus system. If they have any doubts
about your abi6ty, you will likely be recommended for certifica-
tion.
Can I aDDeal the decision if I'm denied? Yes. You simply have
to write a letter to Metro Mobility saying "I want to appeal my
certification decision." At that point your case wi. be reviewed
by an independent appeals board made up of people with
disabirrties. There are agencies that offer help with the appeals
process including REACH and ARC.
I'm ok takina the bus to work every dav. but I have trouble aet-
tina to new Dlaces like the doctor's office and community ac-
tivities. Can I aet helD from Metro Mobilitv? Yes. You may be
able to get "Conditional" certification that would allow you to
use Metro Mobility to get to new locations outside of your daily
route. THIS COULD BE A GOOD OPTION FOR MANY OF YOU!
I think I miaht be able to take the bus if someone helDs me.
What services are available? Metro Mobirlty offers FREE travel
training to help you learn to use as many routes as you need to
get where you want to go. The travel trainer will work with you
one on one until you feel comfortable taking the bus alone.
For more information about Metro Mobirlty and the new certifi-
cation rules, visit www.metrocouncil.org or call the Metro
Mobility Service Center at 651-602-1111.
2
R .1/1 **.
eaCL~r Resources. Inc.
Helping Individuals with Disabilities Reach Their Full Potential
Winter 2009
Schedules
1001 Highway 7. #217
Hopkins. MN 55305
(952) 988-4177 Phone
(952) 988-6728 fax
EDUCATION, THERAPY, LEISURE ACTIVITIES
REACH is an agency that serves individuals with developmental disabilities and their families
in the West and Northwest metro area. Services include counseling. therapy groups, commu-
nity living training and support, therapeutic recreation and leisure, information & referral.
------------------------------------------
Counseling & Education
Counseling
Reach for Resources specializes in
working with people with developmen-
tal disabilities such as mental retarda-
tion, down syndrome. autism. and mild
to borderline cognitive difficulties, and
their families. We believe in a friendly,
supportive, person-centered approach,
and in setting personalized goals for
each client.
Reach accepts: Medical Assistance.
Blue Cross Blue Shield of MN. Medica,
America's PPO.
To schedule an intake interview or for
information on counseling options call
Lisa Rivers, MA. LP at
(952) 988-4177
Empowerment Group
Men and women in this group learn to
support each other. solve their own prob-
lems. advocate for themselves. and form a
strong social network. Participants must
arrange their own transportation and be
able to wait independently for their ride.
WHERE: Eisenhower Center
1001 Highway 7. Hopkins
WHEN: Tuesdays 6:30-8:00 pm
Begins January 13
FEE: $10
An intake is required for new participants.
Call Mary Meyer at 952-988-4177 to register
or schedule an intake.
ARMHS
For Adults with Mental Health Disorders and
Mild Cognitive Impairments
REACH for Resources offers Adult Reha-
bilitative Mental Health Services
(ARMHS) that can help you successfully
live on your own in the setting of your
choice. An ARMHS case worker can
teach you skills to:
. Cope with stress, fea- md alXiEiy
. Rnd &ie, aforda:lle housing
. Rnd a job a1d learn job skills
. Ma1ag6 your money
. Develop a healthy lifestyle
. Learn to use corrmunity res::>urces
Support Group
Young Women in
Transition
(Ages 18-30)
This group provides an opportunity for
women with borderline to mild cogni-
tive disabilities to talk with other women
about their concerns and experiences
regarding relationships, sexuality, grief
and loss, or other topics of interest.
This therapeutic group will meet one evening
per week at the Eisenhower Community
Center in Hopkins. If you would like to be a
part of the group, an intake is required. Call
Lisa at 952-988-4177 for more information.
REACH OUT
Independent Living
Support for
Adults with Disabilities
Reach Out is an in-home support
service for adults with disabilities who
want to live independently, but have
been denied eligibility for other public
assistance programs.
Clients are assigned a case manager
who provides on-going support with:
. Finding Housing
. Finding Employment
. Managing Rnances
. Cooking & Cleaning
. Health & Safety Training
. Socialization
. Transportation
. Government Benefits Application
. Regular phone Check Ins
. Crisis Support
Reach Out is tailored to your individual
needs and offered at an affordable per
session fee.
Sliding scale or no-cost outreach
scholarships may be available based on
family income.
Call Mary Perkins at 952-98-4177 for a Free
Preliminary Assessment
r...........................................................................................................................
I Did You Know? Reach is also a SILS I
~ and Waiver provider. If you are look- !
1 ing for a worker who can meet your i
I..~.~.~~.~.:..=.~~.~..~.~...~...~.~.~~~......................................................1
3
Youth Programs (Ages 5 - 12)
Soccer
6 Weeks of non-competitive soccer for
kids! Learn the basic skills, rules, and
sportsma nship.
WHERE: Garden City Elementary, 3501
65th Ave. N. Brooklyn Center
WHEN: Mondays
Jan 26-Mar 9
TIME:
6:0~6:45 pm
FEE:
$40 Resident
$48 Non-Resident
Bowling
Join us for fun,
non -competitive
open bow6ng.
Youwm bowl two
games each
week
d~
Family
Yoga
Open to ages
5-21
This class is designed for children/teens
with disabilities and their parents to learn
yoga together. Increase attention span,
focus, muscle tone and flexibiHty! Siblings
welcome too. All children must be ac-
companied by at least one adult.
WHERE: Sf. Louis Park Rec Center
3700 Monterey Dr.
WHEN: Tuesdays
Jan 2~Feb 24
TIME: 5:3~6:30 pm
FEE:
$50 for parent/child pair
$55 for non-residents
$20 for each additional person
Registration Notes
and Information
. Residents of our consortium cities
are aiven Driority in reaistration.
Non-resident reaistrations will be
held until one week before the start
of the Droaram.
. If you are a new participant in On the
Town, call Becca at (952) 988-4178 for
information and to schedule an intake
interview.
. Please Note: Participants may only reg-
ister for one social program per quarter.
. Please do not sign up unless you will be
able to attend!
. If you are concerned about your
program filling up quickly, please feel
free to stop by the Reach for Resources
office to complete a registration form in
person.
. You will receive a le"er confirming your
registration along with schedules for al
programs you have been registered for
at least one week prior to the start of
the program.
Winter registration begins November 24
Spring registration will begin Feb. 16
NOTE: REFUNDS ARE NOT GIVEN IF YOU
CANCEL 1 WEEK OR LESS BEFORE THE
PROGRAM BEGINSl
Teen Programs (Ages 13 - 21)
~
Bowling
Join us for fun, non-
competitive bowling.
You wDI bowl two
games each week
Northwest
WHERE:
Doyle's
5000 W Broadway
Crystal
Saturdays
Jan 17-Mar 7
12:00-2:00 pm
$35.00 Resident
$43.00 Non-resident
Plus $3.00 Per Saturday
WHEN:
TIME:
FEE:
West
WHERE:
Park Tavern
3401 Louisiana Ave S
St Louis Park
Saturday
Jan 17-Mar 7
9:30-11:30 am
$35.00 Resident
$40.00 Non-resident
WHEN:
TIME:
FEE:
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 10
Weekend Ventures
(Ages 14-23)
WINTER: Enjoy holiday fun in down-
town Minneapolis. Stay in a hotel, visit
the Macy's holiday display and see the
Holldazzle parade!
WHEN: Dec. 5th-7th
FEE: $350 for entire weekend
SPRING: We will stay at a hotel in
Bloomington and go to the Mall of
America. Shopping, rides, movies, mini-
golf, Underwater World. There is so
much to do!
WHEN: Mar 2Oth-22nd
FEE: $350 for entire weekend
Call Becca at 952-988-4178 for an
application
Active
Adventures
Make friends while trying
new activities. This Is a
social group with an emphasis on outdoor,
active outings.
WHERE: Various northwest metro
locations
WHEN: Thursdays
Jan 15-Feb 26
TIME:
FEE:
Evenings
$40.00 Resident
$48.00 Non-resident
West Teen Explorers
A weekly social group that will explore
your community by enjoying activities
like concerts, plays, shopping, swim-
ming, movies, and eating out.
WHERE: Various West Metro locations
WHEN: Tuesdays, Jan 13-Feb 24
TIME: 6:30 - 8:30 pm
FEES: $40.00 Resident
$45.00 Non-resident
Plus additional activity fee
Program Minimum 5, Maximum 20
Social Seekers
Social Seekers is designed to meet the needs of those with Hlgh-Funcfloning Autism
or Asperger's Syndrome. These fun, age appropriate groups are designed to help
teens and young adults gain confidence In fheir soclallnferacfion skills and make
new friends in a safe environment.
Young Adult Group
ForAges 19+
WHERE: The Depot Coffee House in Hopl4ns
WHEN: Wednesdays, Jon 7-Mar 11
TIMES: Group 1 4:00 - 5:30 pm (Jr. Hi)
Group 2 5:45 -7:15 pm (H.S) TIME: 6:30-8:00 pm
FEE: $200.00 for 10 sessions FEE: $200.00 for 10 Sessions
NEW!! We are adding a Thursday teen group in Robbinsdale. Call for details. I
WHERE:
WHEN:
Teen Groups
The Depot Coffee House il Hopkins
Mondays, Jan 5-Mar 9
I
TEEN PERSONAL PURSUITS: In fhis supplemental program, acflvitles wiD be organized by fhe
Social Seekers Teen groups with fhe help of staff. These activities will be held on Thursdays or
Saturdays. There will be no additional registration fee, but certain activity costs may apply.
Returning participants should contact REACH to register. An intake is reauired for new
DarticiDants. Please call (952) 988-4176.
Take Five Respite
Looking for something fun to do over Win-
ter Break? Come meet new friends at this
great all-day program filled with field
trips, friends and fun!
WHEN:
WHERE:
TIME:
FEE:
Dec. 22,23,26,29,30, & Jan. 2
Elim Lutheran In Robblnsdale
9:00 am-3:30 pm
$70 per day
Transportation may be avaDable lor an additional lee.
Payment Options: Private pay, Waiver, PCA &
CDCS. Some scholarships are available.
For an application, please
call Stephen at (952) 988-5321
Girls Club
This club Is designed for girls ages 13-17
who are Independent in their personal
care and want to meet new friends and
have fun!
WHEN:
One Saturday per month,
beginning In January
Various locations
$40.00 Resident
$45.00 Non-resident
WHERE:
FEE:
5
Adult Fitness
Adult Bowling t{!'~1
Join us for fun, non-
competitive bowling.
You wDI bowl two ~
games each week
Northwest
WHERE: Doyle's
5000 W Broadway
Crystal
WHEN: Saturdays
Jan 17-Mar 7
TIME: 12:00-2:00 pm
FEE: $35.00 Resident
$43.00 Non-resident
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 30
WHERE: Earle Brown Bowl
6440 James Cir N
Brooklyn Center
WHEN: Saturdays
Feb 14-Mar 21 (6 wks onlv)
TIME: 3:00-5:00 pm
FEE: $28.00 Resident
$36.00 Non-resident
Plus $4.00 Per Sunday
Program Minimum 5, Maximum 30
West
WHERE: Park Tavern
3401 Louisiana Ave S
St Louis Park
WHEN: Saturday
Jan 17-Mar 7
TIME: 9:30-11 :30 am
FEE: $35.00 Resident
$40.00 Non-resident
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 30
Yoga for Adults
(ages 18+)
Relax, gain flexibility, and get in shape at
this great program.
WHERE: Sf. Louis Park Recreation Center
3700 Monterey Dr.
Sf. Louis Park
WHEN: Tuesdays
Jan 20-Feb 24
6:45 - 7:45 pm
$40.00 Resident
$45.00 Non-resident
Program Minimum 5, Maximum 20
Call Becca at (952) 988-4178 for details
TIME:
FEE:
Walking Club
Keep that body moving and enjoy the
community! We will walk at various in-
door and outdoor locations.
WHERE:
WHEN:
Various Locations
Non-Competitive
Basketball
t
TIME:
Mondays
Jan 19-Feb 23
6:30 . 8:00 pm
$25.00 Resident
$30.00 Non-Resident
Have fun and get some exercise in this
great non-competitive league!
WHERE: Forest Elementary School
6800 47th Ave. N.
Crystal
WHEN:
Thursdays '
Jan. 8-Mar 12
6:30 - 8:00 pm
FEE:
Program Minimum 5, Maximum 15
TIME:
FEE:
$40.00 Resident
$45.00 Non-resident
A Competitive Basketball League is
offered by the Ridgedale YMCA on
Mondays. Call Molly at 952-982-8264
for information.
The Adaptive Recreation program Is a cooperative effort between REACH for Resources nd the Northwest Consortium and West Consortium of
cities. The Northwest Consortium consists of: Brooklyn Park, Brooklyn Center, Crystal, Golden Valley, Maple Grove, New Hope, Plymouth and Rob-
blnsdale. The West Consortium consists of: Chanhassen, Chaska, Hopkins, Minnetonka, and St. Louis Park. For information and registration pro-
cedures, call Tara or Becca at 952-988-4177. NOTE: For persons not living In one of the above communities, you are considered a "non-resident"
and need to add a $8 to the registration fee for Northwest city programs and $5 to the registration fee for West city programs.
6
Adult Social Pro
On the Town I
A social group for young aduls, ages 18-25,
who are independent and would iI<e to
eJq)lore ther community. Meets twice per
month.
WHERE: Various locations in the Northwest
& West Suburbs
WHEN: Every other Fridayeveni1g
BeginningJan16
TIME: Varies with activiy
FEE: $20.00 Resident
$25.00 Non-resident
Plus additional activity fees
Program Mininum 5, Ma>inum 15
On the Town II
A social group for adults. ages 26 - SO, who
can access the community independently
wih mininal supeMsion. 'JINo Saturdays per
month.
WHERE: Various locations in the Northwest
& West Suburbs
WHEN: Every other Saturday evening
BeginningJan17
TIME: Varies with activiy
FEE: $20.00 Resident
$25.00 Non-resident
Plus additional activity fees
Program Mininum 5, Ma>inum 15
rams
Club West (west metro) and Wednesday Night Social (northwest metro }are
social programs for adults age 18and older. Meet new friends and visit with
old friends while enjoying games, dances, movies, bingo, etc.
Staff to participant ratio is 1:10
Program Milimum 5, MaJi'num 30 (for each program)
Club West Wednesday Night Social
WHERE: Various west metro WHERE: Crystal Community Center (and
locations other nearby locations)
WHEN: Wednesdays WHEN: Wednesdays
Jan 14-Mar4 Jan 14-Mar4
TIME: 6:30 - 8:30 pm TIME: 6:30 - 8:30 pm
FEE: $40.00 Resident FEE: $40.00 Resident
$45.00 Non-resident $48.00 Non-resident
Plus additional activiIyfee Plus additional activiIy fee
~........................................................................................"
. .
. .
. .
I Weekend Ventures I
I (Ages 24+) I
j WINTER: Enjoy holiday fun in down- ~
j town Minneapolis. Stay at a hotel, visit ~
1 the Macy's holiday display and see the 1
i Holidazzle parade! i
! WHEN: December 5-7 I
j FEE: $350 for entire weekend .::::::.~
SPRING: We wiD stay at a hotel in
Bloomington and go to the Mall of
America. Shopping, rides, movies,
1 mlni-golf, Underwater World. There is so
l much to do!
i WHEN: Mar 201h-22nd
IFEEF:'.~~~;:.~~(;;;;~;~;tl__,
Friday Night Dances
Join your friends and groove to all the
latest hits! Sponsored in collaboration
with Project Soar.
TIME:
FEE:
WHEN:
7 .9 pm (all dances)
$5.00 at the door
Jan. 23
Feb 13
Mar 13
SI. louis Park High School
6425 W. 33rd SI.
WHERE:
WHEN:
WHERE:
Feb. 27
Maple Grove Jr. High
7000 Hemlock In.
7
Registration Form-Winter 2009
Advance payment is required for all programs. NO REGISTRATION AT PROGRAMS OR BY PHONE. To ensure a spot in the program(s)
of your choice, mail in payment and registration form as soon as possible. Residents of the West & Northwest consortium of cities
receive preference in registration. See bottom of page 6 for list of cities. Registration is then open to non-residents one week prior
to the start of the programs (unless program is full). Registration Begins November 24, 2008
Name:
Birth date:
Address:
City:
Zip Code:
Home Phone:
Work Phone:
Email:
Emergency Contact: Emergency Phone:
DYes 0 No I have waivered services and an authorization for Reach For Resources to bill for these programs.
DYes 0 No Do you require wheelchair access?
Photo Waiver: My photo may be taken at Reach programs and used for promotional materials, unless I check below:
o No. I DO NOT wish to have my photo used.
Disability (please include specific information such as seizures, allergies. special diet etc.):
Social Worker:
Parent(s}/Guardia n(s}:
Home Address:
Parent(s} E-Man:
Parent(s}Employer:
Employer Address:
Annual House- 0 $0. $24.999
hold Income: 0 $100.000. $124,999
Social Worker's Phone:
Parent/Guardian's Phone:
City:
Parent(s} Cell Phone:
Employer Phone:
Zip:
o $25.000 . $49.999
o $125,000. $149,999
City:
o $50,000 . $74,999
0$150,000. $174.999
Zip:
o $75,000 .99,999
0$175,000. $199,999
o $200,000+
I. the underslgned. certify that the above Information Is accurate. I understand that participation In this activity Is completely voluntary and the activity Is being offered
for the benefit of the participant. Reach for Resources shall not be Dable for any claims. InJuries. or damages of whatever nature. Incurred by the participant arlslng out
of. or connected with. the activity. On behalf of myself and the participant. I expressly forever release and discharge Reach for Resources. Its agents or employees. from
any such claims. InJuries or damages. I have received a copy of Notice of Privacy as required by HIPAA. I have read. understood and agree to these privacy practices.
Legal Guardian:
Date:
0 Program Resident/Non-Res
D Adult Bow6ng Doyle's $35.00 / $43.00
D Adult Bow6ng Earle Brown $28.00 / $36.00
D Adult Bow6ng Park Tavern $35.00 / $40.00
D Youth/Teen Bowling Doyle's $35.00 / $43.00
D Youth/Teen Bowling ParkTav. $35.00 / $40.00
D Kid Fu Session # - $56.00 / $61 or $64
D Family Yoga (# attending-l $50.00/ $55 (+$20)
D Youth Soccer $40.00 / $48.00
D Active Adventures $40.00 / $48.00
D West Teen Explorers $40.00 / $45.00
Winter
2009
0 Program Resident/Non-Res
D Girls Club $40.00 / $45.00
D Basketball-Adult $40.00 / $45.00
D Adult Yoga $40.00 / $45.00
D On the Town I $20.00 / $25.00
D On the Town II $20.00 / $25.00
D Club West $40.00 / $45.00
D Wednesday Night Social $40.00 / $48.00
D Walking Club $25.00 / $30.00
D Holiday Party (# attending ) $5.00 ea
D Superbowl Party $7.00
D Take Five Respite Send me info
D Weekend Ventures Send me Info
Please mail completed form with payment to Reach at:
1001 Highway 7 #217Hopkins, MN 55305
Office (952) 988-4177 www.reachforresources.org
Best Male Costume winner Alex Luther (aka
Michael Phelps) poses with Executive Director
Mary Perkins
a
at the
on
over
will be used to
scholarship
people in
,-II
./)
R
Park lion's Club
American
Grove lions Club
Jim and Cyndi Bade
Mary Beckering
Tony Boldon
Patrick Boley
Steve and Marcia Crist
Ruth Ann Kempf
Barb and Dave Kleist
Maxine and Jeff Skold
a
AUlson Henley as Cruella DeVille won
Best Female Costume
Applebee's
Arbys
Brunswick Zone
Chipotle
Country Glazed Ham
Cub Foods
Erbert N Gerbert's
Fantastic Sam's
Famous Dave's
50's Grill
Leeann Chin
Minnesota T1mberwolves
Minnesota Twins
Minnesota Vikings
Noodles & Company
Old Log Theater
Olve Garden
Papa Murphy's
Potbelly Sandwiches
Red Lobster
Rocky Rococo Pina
Sam's Club
Stages Theatre Company
Subway
Taco Bell
Target
Three Squares Restaurant
Hammer
The Goldbrick Club
Twin Cities Single Volunteers
Park Center High School
Champlin Park High School
Special Thanks to the
Brooklyn Park Community
and Jen
the
9
Address Service Requested
1001 Highway 7 #217
Hopkins, MN 55305
(952) 988-4177