Administrative Packet
Administrati ve
Packet
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Yow are-lNWitetLw- CiffteNLdA
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Act'wulR4'& AthlRr~G~
SatUY~, Mar~ 21, 2009
6pWl/
M~L~e-
ArboretUWII
The Gala will be held at the University of Minnesota Landscape Arboretum
Oswald Visitor Center
6:00 Social Hour - Silent Auction Opens, Raffles
7:00 Traveling Dinner - Silent Auction, Raffles Continue
9:00 Hall of Fame Program and Live Auction
10:00 Dessert, Coffee
Tickets are $50 per pE!rson and include one drink ticket and a "Traveling Dinner".
~
Additional drink tickets will be $5 each.
The attire for the evening is semi-formal.
The goal for the fundraiser this year is to raise monies to upgrade the sound systems at the
CHS football stadium and main gymnasium, the soccer stadium next to CMSW, the
swimming pool in CMSE, and to purchase a portable sound system that can be used at other
sport and activity venues off site.
RESERVATIONS: can be made online at www.ce4all.or~ or the Activities
Office beginning the middle of January. Questions: 952.556.7'30
Please share this information with friends and plan to bring a group
to the 2009 Gala
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Reach for Resources, Inc.
t
Spring
2009
1001 Highway 7
Hopkins, MN 55305
Room 217
Phone: 952-988-4177
Fax: 952-988-6728
Helping Individuals with Disabilities Reach Their Full Potential
The *,*""
2008 REACH Annual Awards
I,
Presented on December 9, 2008 at the Reach Annual Meeting and Holiday Party
Maxine Skold
Zachary Lane School
Secretary
Self-Advocate of the Year: Alex Luther
Alex Luther was chosen as the 2008 Self-Advocate of the Year
for his unrelenting drive to better himself. He is doing well at
work, lives on his own, and is continually becoming more
independent. His positive attitude and enthusiasm are an
inspiration to everyone he meets.
Civic Sponsor: Osseo lions Club
The Osseo Lions Club has been a loyal supporter of the REACH
mission for several years now, providing funding for general
operations, as well as sponsorships for special events such as the
Bowl-A-Thon. The Lions support a variety of worthy causes in the
community and REACH is very grateful that they have chosen to
make disability services one of them.
Leon Miller of fhe Osseo
lions Club.
Volunteer of the Year: Patrick Boley
Patrick has been a tireless Volunteer for REACH for several
years. Not only does he serve as President of the Board of
Directors, he has also testified on behalf of REACH in front of the
Hennepin County Commissioners, solicited crucial funding, and
acted as "The Wizard-fortune-Teller Extraordinaire," at the
Ghostly Gala. Thank you Patrick for your excellent work on be-
half of people with disabilities!
Kari
US Bank
Kelsey Shuff
Major, Lindsey &
Africa, LLC
(Continued on page 11)
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UPCOMING SPECIAL EVENTS
Don't Miss Our Fabulous Annual Fundraiser!
Date: Saturday, May 2nd
Time: 9:30 am - 1 :00 pm
Location: New Hope Bowl, 7107 42nd Ave. N. in New Hope
9:30 a.m.
10:00 - 12:00
12:00 - 1 :00
Event Schedule
Registration
Bowling
Lunch and Awards
Prizes and awards
given for top pledge
gatherers and top
bowling scores!
Cost:
Bowlers gather pledges or make a donation
for this fundraising event.
Minimum pledqe/donation: $40 For your donation you
will receive 2 bowling games, lunch, and at-shirt.
I **Fabulous prizes are awarded for top pledge gather-
. ers. The winner last year raised over S 1800 in pledges to
support Reach programs! **
Not a bowler? With a tax-deductible donation of $15,
spectators can watch the fun and join us for lunch.
Everyone Welcome!
Clients, families, and friends of
Reach are invited to join us for a
morning of fun and fundraising!
You can form your own team of 4-5 people,
or sign up to bowl individually and we'll assign
you to a team.
Register today
by using the
form on page 10
in this newsletter
Bowl-A- Thon Sponsors and
Prize Donations Needed
Give back to the community and advertise your
business at the same time by becoming a Reach
Bowl-A-Thon Sponsor or Prize Donor!
Contact Cyndi Bade at 952-9884177 or
cbad e@reachforresources.org.
Carver County Fun Fest
Q0
/
Carver County residents are invited to come visit with local recreation vendors to learn about summer
programs and enjoy some fabulous music!
WHEN: Wednesday, April 15th from 6:30 to 8:30 p.m.
WHERE: Chaska Community Center, 1661 Park Ridge Dr., Chaska
COST: Free!
Sponsored by Reach and Magnifying Abilities
\
2
Spring 2009
R 11/J **~
eaCn-'? for Resources
Inc.
c e u es
Helping Individuals with Disabilities Reach Their Full Potential
EDUCATION, THERAPY, LEISURE ACTIVITIES
1001 Highway 7, #217
Hopkins, MN 55305
(952) 988-4177 Phone
(952) 988-6728 fax
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
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 High-
way 7, Hopkins
WHEN: Tuesdays 6:30-8:00 pm
Begins April
FEE: $10
Call at 952-988-4177 to register. An
intake is required for new participants.
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 gress, fear and anxiety
. Rnd scte, affordctJle housing
. Rnd ajob md learn job skills
. Mancg3 your money
. Develop a healthy lifestyle
. Learn to use community rerources
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
Life Skills Support for
Adults with Disabilities
Reach Out is a private pay in-
home support service for adults with
disabilities who want to live independ-
ently, but have been denied eligibility
for other public assistance programs.
Clients are assigned a case manager
who provides on-going support with:
. Housing
. Employment
. Managing Finances
. Health & Safety
. 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.
Partial or full scholarships may be available
based on family income.
Call Mary Perkins at 952-98-4177 for a Free
Preliminary Assessment
Did You Know? REACH is also a SILS
and Waiver provider. If you are
looking for a worker who can meet
your needs, give us a call!
3
Youth Programs (Ages 5 - 12)
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 flexibility! Siblings welcome too. All children
must be accompanied by at least one adult.
WHERE: St. Louis Park Rec Center, 3700 Monterey Dr.
WHEN: Tuesdays, Apr 7-May 12 FEES: $50 for parent/child pair
TIME: 5:30-6:30 pm $55 for non-residents
Co-sponsored by Project Soar
$20 for each additional person
d~ Kid Fu
Fun martial arts programs for
kids. Come learn the moves
of Jackie Chan! Now 8
weeks!
Bowling
Join us for fun, non-competitive
open bowling. You will bowl two SESSION 1
games each week WHERE: Bass Lake Shelter
5450 Northwest Blvd.
Northwest Plymouth
WHERE: Doyle's WHEN: Thursdays
5000 W Broadway April 2-May 21
Crystal TIME: 6:00-6:45 pm
WHEN: Saturdays FEE: $56.00 Resident
Mar 28-May 16 $64.00 Non-resident
TIME: 12:00-2:00 pm
FEE: $35.00 Resident SESSION 2
$43.00 Non-resident WHERE: Chanhassen Rec. Ctr.
Plus $3.00 Per Saturday 2310 Coulter Blvd.
Chanhassen
WHEN: Wednesdays
West April1-May 20
WHERE: Park Tavern TIME: 6:00 - 6:45 pm
3401 Louisiana Ave S
St Louis Park FEE: $56.00 Resident
WHEN: Saturdays $61.00 Non-resident
April 4-May 23
TIME: 9:30-11 :30 am
FEE: $35.00 Resident Program Minimum 5, Maximum 10
$40.00 Non-resident For more information, call
Plus $3.00 Per Saturday Becca at (952) 988-4176
Program Minimum 5, Maximum 10
4
Inclusion Services
Reach for Resources provides
inclusion facilitators for children
with disabilities who would like
to participate in their city park
and recreation programs.
Registration for these programs
is done through your park and
recreation department. After
registering, contact Reach for
Resources to discuss the needs/
,~<:~ommodt~~;~n for yours~l~i:pr
your child. We require a>',:;:,mii'
minimum of two weeks notice
for a successful inclusion.
Becc9i(.1t(952) 988-4176
for .0'19r~mil'lformation
h'<;;;j''',
Registration Notes
and Information
. Residents of our consortium cities
are Cliven priority in reClistration.
Non-resident reClistrations will be
held until one week before the start
of the prOClrClm.
. If you are a new participant in On the
Town, call Becca at (952) 988-4176 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 letter confirming your
registration along with schedules for all
programs you have been registered for
at least one week prior to the start of
the progra m.
Spring registration begins Feb. 16
Summer registration begins May 1
NOTE: REFUNDS ARE NOT GIVEN IF
YOU CANCEL 1 WEEK OR LESS
BEFORE THE PROGRAM BEGINS!
Teen Programs (Ages 13 - 21 )
!
Bowling
Join us for fun, non-
competitive bowling.
You will bowl two
games each week.
Northwest
WHERE:
Doyle's
5000 W Broadway
Crystal
Saturdays
Mar 28-May 16
12:00-2:00 pm
$35.00 Resident
$43.00 Non-resident
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 10
WHEN:
TIME:
FEE:
West
WHERE:
Park Tavern
3401 Louisiana Ave S
St Louis Park
Saturdays
April 4-May 23
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
Need a mini-vacation? Join us for our
great weekend. respite programs.
Participants are dropped off Friday
evening and spend the entire
weekend having fun under the caring
supervision of our experienced staff.
We have two trips planned for partici-
pants ages 14 to 25: One to Mall of
America and one to Valley Fair.
See paae 7 for details.
West Teen Explorers
Active
Adventures
Make new friends while trying new ac-
tivities. This is a weekly social group that
give teens the opportunity to go to
concerts, restaurants, movies, plays,
sporting events, shopping and more!
Make friends while trying
new activities. This is a
social group with an
emphasis on outdoor,
active outings.
WHERE:
Various west metro
area locations
Tuesdays
Mar 31-May 12
Various northwest metro
locations
Thursdays
Apr 2-May 14
WHEN:
WHERE:
WHEN:
TIME:
6:30 - 8:30 pm
$40.00 Resident
$45.00 Non-resident
Plus additional activity fee
Program Minimum 5, Maximum 20
FEE:
Evenings
$40.00 Resident
$48.00 Non-resident
TIME:
FEE:
Social Seekers
Social Seekers is designed to meet the needs of those with High-Functioning Autism
or Asperger's Syndrome. These fun, age appropriate groups are designed to help
teens and young adults gain confidence in their social interaction skills and make
new. friends in a safe environment.
Teen Groups Young Adult Group
WHERE: The Depot Coffee House in Hopl4ns For Ages 19+
WHEN: Mondays, March 23-June 1 WHERE: The Depot Coffee House in Hopl4ns
4:00 - 5:30 (age 12-14) WHEN: Wednesdays, March 25-June 3
TIMES:
5:45 -7:15 (age 15-18) TIME: 6:30 - 8:00 pm
FEE: $200.00 for 10 Sessions
WHERE: Bin Lutheran in Robbinsdale
WHEN: Thursdays, March 26-June 4
TEEN PERSONAL PURSUITS
TIMES: 5:00 - 6:30 pm (age 15-18)
In this supplemental program, activities
FEE: $200.00 for 10 Sessions will be organized by the Social Seekers
Teen groups with the help of staff. These
activities will be held on Thursdays or Sat-
Returning participants should contact REACH urdays. There will be no additional regis-
to register. An intake is reauired for new tration fee, but certain activity costs
participants. Please call (952) 988-4176. may apply.
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 May
WHERE:
FEE:
Various locations
$40.00 Resident, $45.00 Non-resident
5
Adult Fitness
Adult Bowling
Join us for fun, non-
competitive bowling.
You will bowl two
games each week
Northwest
WHERE: Doyle's
5000 W Broadway
Crystal
WHEN: Saturdays
Mar 28-May 16
TIME: 12:00 - 2:00 pm
FEE: $35.00 Resident
$43.00 Non-resident
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 30
Earle Brown Bowl
6440 James Cir N
Brooklyn Center
Saturdays
Mar 28-May 16
3:00-5:00 pm
$35.00 Resident
$43.00 Non-resident
Plus $4.00 Per Saturday
Program Minimum 5, Maximum 30
WHERE:
WHEN:
TIME:
FEE:
West
WHERE: Park Tavern
3401 Louisiana Ave S
St Louis Park
WHEN: Saturdays
April4-May 23
TIME: 9:30 - 11 :30 am
FEE: $35.00 Resident
$40.00 Non-resident
Plus $3.00 Per Saturday
Program Minimum 5, Maximum 30
6
Yoga for Adults
(ages 18+)
Relax, improve your flexibility and get in
shape with this great yoga class. Taught
by certified yoga instructor Ann Mertes.
WHERE: St. Louis Park Rec Center,
3700 Monterey Dr.
Tuesdays
April7-May 12
6:45 - 7:45 pm
$40.00 Resident
$45.00 Non-resident
Program Minimum 5, Maximum 15
Call Becca at (952) 988-4176 for details
WHEN:
TIME:
FEE:
Co-sponsored by Project Soar
Walking Club
(ages 18+)
Keep that body moving and enjoy the
community with friends.
WHERE: Various Indoor and Outdoor
Locations
WHEN:
Mondays
April 13--May 18
6:30 - 8:00 pm
$25.00 Resident
$30.00 Non-resident
TIME:
FEE:
Program Minimum 5, Maximum 15
Call Becca at (952) 988-4176 for details
~"
Canoe the Chain
of lakes!
Get outside and enjoy Minnesota's
beautiful lakes! Learn the basic skills
needed to canoe and then spend the
afternoon paddling on the Chain of
Lakes in Minneapolis. This program is
appropriate for all ability levels.
Instruction, guides and adaptive
equipment will be provided by
Wilderness Inquiry.
WHEN:
TIME:
FEE:
Sunday, May 17
12:00-4:00 pm
$40.00 Resident
$45.00 Non-Resident
Call Becca at (952) 988-4176 for more
information.
Adult Social Programs
On the Town I
A social group for young aduls,ages 18-25,
who are independent and would 6ke to
e}((.)lore ther community. Meets twice per
month.
WHERE: Various locations in the Northwest
& West Suburbs
WHEN: Every other Friday evening
Beginning April 3
TIME: Varies with acfivity
FEE: $20.00 Resident
$25.00 Non-resident
Plus additional activity fees
Program Mininum 5, Mam,um 15
Weekend
Ventures
Need a mini-vacation? Join us for these
great weekend respite programs.
Participants are dropped off Fridayeve-
ning and spend the entire weekend hav-
ing fun under the caring supervision of
our experienced staff.
Mall of America:
We will stay in a hotel in Bloomington
and spend all day Saturday at Mall of
America. Shopping, rides, movies, mini-
golf, Underwater World-this will be an
exciting weekend!
WHEN: March 20-22 (ages 14-25)
March 27-29 (ages 26+)
FEE: $350 for entire weekend
Vallev Fair:
We will stay in a hotel in Shakopee and
spend all day Saturday at Valley Fair.
Ride the roller coasters, see a show, have
fun in the water park, and so much
more!
WHEN: June 12-14 (ages 14-25)
June 26-28 (ages 26+)
FEE: $350 for entire weekend
For more information or for an
application, please call Becca at
(952) 988-4176
On the Town II
A social group for adults, ages 26 - 50, who
can access the community independently
with minimal supervision. Two Satuldays per
month.
WHERE: Various locations in the Northwest
& West SubuJbs
WHEN: Every other Satulday evening
Beginning ApIi 4
TIME: Varies with acfivity
FEE: $20.00 Resident
$25.00 Non-resident
Plus additional activity fees
Program Mininum 5, Mam,um 15
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, MaJtnum 30 (for each program)
Club West Wednesday Night Social
WHERE: Various west metro WHERE: Crystal Community Center (and
locations other neaJby locations)
WHEN: Wednesdays WHEN: Wednesdays
April1-May2O April1-May20
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 ac1iviIyfee Plus additional ac1ivity fee
Friday Dances
Join your friends and groove to all the latest hits! Sponsored in collaboration with
Project Soar.
WEST
WHERE: St. Louis Park High School
6425 W. 33rd Sf.
WHEN:
TIME:
FEE:
April 17 , May 15, June 19
7 - 9 pm
$5.00 at the door
NORTH
WHERE: Crystal Community Center
4800 Douglas Dr. N.
WHEN:
TIME:
FEE:
May 1
7-9pm
$5.00 at the door
7
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SUMMER 2009 PREVIEW
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As another summer approaches, we are busy planning and preparing to meet your summer recreational needs.
Summer is a time to meet new friends, experience new things and enjoy the outdoors. Reach For Resources has a wide variety
of exciting programs for all ages. Check out some of the highlights below. Summer Registration Begins May 1.
Youth
Sports Sampler:
Sessions in Chanhassen &
Brooklyn Park
Auaust Action:
Mini-day camp exploring
a variety of hot spots
BowlinCl:
Sf. Louis Park & Crystal
Adults
Softball:
Non-competitive league
Bowlina:
Sf. Louis Park & Crystal
Great Social Clubs:
Several different options
meeting in the West & North
suburbs
Friday Niaht Dances:
Come with friends and
dance the night away
Teens
Softball:
Non-competitive league
Teen Explorers:
Social clubs meeting in the
West & North suburbs
Bowling:
Sf. Louis Park & Crystal
Active Adventures:
Fun outdoor activities
Summer Inclusion and
Playground Opportunities
Reach For Resources provides inclusion facilitators for chil-
dren and teens with disabilities who participate in their city
summer playground programs or any other park and recrea-
tion offering. Registration for such park and recreation pro-
grams is done through your city park and recreation depart-
ment. Once you have registered, please contact Reach,
calling the appropriate staff person listed below, to discuss
the needs/accommodations for your child. Cities served
include: Brooklyn Park, Brooklyn Center, Chanhassen,
Chaska, Crystal, Golden Valley, Hopkins, New Hope, Minne-
tonka, Robbinsdale, & St. Louis Park.
Call Becca at 952-988-4176 at least 2 weeks before the
program to schedule an inclusion.
Respite Programs
Do you need something to do during your summer
break? We have lots of great options!
Take Five Respite-A day program for ages 13-21. Runs
from 9:00am to 3:30 pm. August 3-28
Weekend Ventures-overnight programs for teens and
adults. Runs June 12-14 (teens) and June 26-28 (adults).
Part-Time Adaptive Recreation Positions Available
Reach For Resources is accepting applications for Recreation Program staff. Applicants will work
with chDdren and adults with developmental disabilities in a variety of recreational settings.
~each is seeking individuals with a background in Therapeutic Recreation, Adaptive Physical
..... Education, Paraprofessional, or related fields, and interest in working with people with disabilities
in fun and exciting recreational programs. These positions are perfect for college students, fam-
ily members, or school district employees looking for extra money.
Starting rate is $9.00 per hour.
AvaDable hours range from 2 to 20 hours per week
Program locations are in the Northwestern and Western suburbs of Hennepin County.
. .
.....
For more information on the available positions
or to request an application, call Becca at 952-988-4176.
Name:
Address:
City:
Phone:
Email:
,1n I<.'f-
Reac f ~: "'0"',", '0<
2009 BOWL-A-THON REGISTRATION
You must be registered in order to bowl. We will send you a pledge packet
when we receive your registration form.
Registration Deadline: April 15, 2009
State
Zip
Please register me for:
o Bowling and Lunch-$40 minimum pledges or donation (Pledges should be turned in at the event)
I am bowling alone
T -Shirt Size: S M L XL XXL [adult sizes only]
(circle one)
I am bowling with a team*
Other team members:
*(N~te:. ALL Team Members must fill out their own registration form)
o Lunch Only-My $15 donation is enclosed (checks payable to Reach for Resources).
o
I am unable to participate, but enclosed is my donation of $
for Resources).
. (checks payable to Reach
Photo Waiver: Photos may be taken at the Bowl-A-Thon and used in Reach publications. If you DO
NOT want your photo used, initial here: No, I do not want my photo used
10
Reach Annual Awards, continued from page 1:
Community Partner: The Depot Coffee House
For over two years, The Depot Coffee House in Hopkins has been a wonderful supporter of our
Social Seekers programs for teens and young adults with Asperger's Syndrome. They provide a
fun, safe environment for participants to be themselves and interact with peers. Thankyou to
The Depot for helping Reach make this therapeutic recreation program such a success!
Patrick and Fran trom the Depot
First Annual REACH Talent Showcase Featured Client Work
Charlie Miller proudly displays his drawings
Reach For
Thank you to all of you who offered your impressive
talents for display at the Annual Holiday Party:
Alex Luther-photography
Charlie Miller-original drawings
Dave Plocek-photo collage
Melissa Rogers-original paintings
Kristin Skold-original painting
Leah Wallin- cross stitch
Photos by Dave Plocek
Cross stitch submitted
by Leah Wallin
We look forward to expanding the Talent Showcase
next year!
Please Give to the REACH 2009
Annual Fundraisina Appeal!
Do you buy ink and toner for your home
or business?
REACH services make up a crucial sup-
port network in the lives of our clients.
We just can't let them down.
REACH is very excited to partner with TonerForAutism.com to gener-
ate awareness and raise money for our mission.
Thank you for your support this year!
Please send your tax-deductible
donation today to:
It you or your employer buy toner and ink from their website
(www.TonerforAutism.com). REACH will receive 5% ot all your pur-
chases now and into the tuture. They ofter competitive prices, a
huge variety of products, and accept all major credit cards.
What a great way to contribute to REACH
without spending any extra money!
REACH
1001 Hwy 7, #217
Hopkins, MN 55305
REACHJS GOING GREEN!
PLEASE HELP US SAVE MONEY AND RESOURCES on printinaand post..
aae by sianinauptoreceive The Reach Reader electronically.
It's.alnhe same great news and program schedules delivered conveniently
each quarter to your email address.
To sign up, send your name andemail.addressto
enews@reachforresources.org
P.S. The Reach Reader is also always available at ourwebsite:www.reachforresources.ora
11
'7 -,\~7~,.".,..:
Registration Form-Spring 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. Registration is then open to non-residents of the consortium cities one week prior to the start of
the programs (unless program is full). Registration Begins February 16, 2009
Name:
Birth date:
Address:
City:
Zip Code:
Home Phone:
Work Phone:
EmaD
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.
DisabDity (please include specific information such as seizures, allergies, special diet etc.):
Social Worker:
Parent(s)/Guardian(s):
Home Address:
Parent(s) E-Mail:
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:
0$25,000 - $49,999
o $125,000 - $149,999
City:
0$50,000 - $74,999
0$150,000 - $174,999
Zip:
0$75,000 - 99,999
0$175,000- $199,999
o $200,000+
I. the undersigned, 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 shaH not be Dable for any claims, injuries, or damages of whatever nature, incurred by the participant arising 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.' 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
0 Adult Bowling Doyle's $35.00/ $43.00
0 Adult Bowling Earle Brown $35.00 / $43.00
0 Adult BoWRng Park Tavern $35.00 / $40.00
0 Youth/Teen Bowling Doyle's $35.00 / $43.00
0 Youth/Teen Bowling ParkTav. $35.00 / $40.00
0 Kid Fu (Session:# ) $56.00 / $61 or $64
in West Teen EXDlorers $40.00 I $45.00
0 Family Yoga $50.00 / $55 (+$20)
0 Girls Club $30.00 / $35.00
0 Active Adventures $40.00/ $48.00
Spring
2009
0 Program Resident/Non-Res
0 Canoe Trip $40.00 / $45.00
0 Walking Club $25.00 / $30.00
0 Yoga for Adults $40.00 / $45.00
0 On the Town I $20.00 / $25.00
0 On the Town II $20.00 / $25.00
0 Club West $40.00 / $45.00
0 Wednesday Night Social $40.00 / $48.00
0 Weekend Ventures Send me info
0 BOWL A THON Register on back of this sheet
Please mail completed form with payment to Reach at:
1001 Highway 7 #217Hopkins, MN 55305
Office (952) 988-4177 www.reachforresources.org