Recreation - Accessible Pursuits Services Request

2. Welcome to Accessible Pursuits
   This program is Adaptive Recreation Services avenue for customizing recreation services specific to groups with disabilities/medical conditions needs. We hope to support your group's recreation needs! To start, please take a few moments to complete this form.

   This program is Adaptive Recreation Services avenue for customizing recreation services specific to groups with disabilities/medical conditions needs. We hope to support your group's recreation needs! To start, please take a few moments to complete this form.

4. Contact Name*

5. Organization*

7. Email*

8. Phone #

10. Date(s) requesting

12. Group size

13. Ages of participants

    1. Youth

    1. Adults

15. Program needs (equipment, facility, etc.)

    1. Equipment - bikes, sport wheelchairs, game supplies, etc.
    2. Programming - facilitator, trip, event, weekly class, etc.
    3. Transportation with lift

    1. Facility use
    2. Other

17. What other program needs do you have?

19. Program Description*

    Please provide a brief description of your program interest and your groups demographics.

21. An Adaptive Recreation specialist will contact you within three business days to discuss determine next steps. For more information call Hilyard Community Center 541-682-5311. Thank you!

    An Adaptive Recreation specialist will contact you within three business days to discuss determine next steps. For more information call Hilyard Community Center 541-682-5311. Thank you!

23. Note: The City of Eugene uses this contact form to protect your privacy and to help prevent spam

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

    This field is not part of the form submission.

27. Submit Submit and Print

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