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Therapeutic Recreation Program Registration Form

  1. Please review all information in the TRS brochure to ensure you are registering for appropriate programs according to descriptions and guidelines. All new participants must complete an Assesment with a TRS staff and a Participant Health Form before participating in TRS programs. Registrations will be processed the morning of registration in the order in which they were received, and may be submitted prior to the registration date. You may submit up to 10 courses on this form,

  2. Participant Residency*

    Check one:

  3. Do you give permission for an exchange of information between TRS and Participant’s Caseworker?*

  4. Is accessible transportation required?*

  5. Would you like to register for another course?

  6. Would you like to register for another course?

  7. Would you like to register for another course?

  8. Would you like to register for another course?

  9. Would you like to register for another course?

  10. Would you like to register for another course?

  11. Would you like to register for another course?

  12. Would you like to register for another course?

  13. Would you like to register for another course?

  14. Valentine's Dance -Additional Questions

    Please answer the questions below ONLY if you are registering for an upcoming Valentine's Dinner Dance

  15. Are you attending with a group home?

  16. Do you require a sugar free dessert?

  17. Do you require a specialized meal?

  18. Sub Total Fees ------------------------------------------->

  19. TOTAL FEES (Program Fees + Transportation Fees) ----------------------------->

  20. Payment is due before the start of programs. For registration questions please contact Therapeutic Recreation Services at (540) 772-7529 ext. 2.

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