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Adaptive and Inclusive Recreation (AIR) Commissioner Amanda Fritz Director Mike Abbaté Summer 2016 REGISTRATION BEGINS APRIL 18, 2016 Go to PortlandParks.org, click on the Register Now tab. • Adaptive Skate Camp... see page 5 • Bowling... see page 4 • Trips... see pages 8-12

Adaptive and Inclusive Recreation (AIR) Summer activities 2016

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The Adaptive and Inclusive Recreation (AIR) program offers community-based recreation activities and leisure services specially designed for youth through adults who have a disability or special need. Our services assist people to develop and use their leisure time in ways to enhance their health, independence and well-being.

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Adaptive and Inclusive Recreation (AIR)

Commissioner Amanda FritzDirector Mike Abbaté

Summer 2016

REGISTRATION BEGINS APRIL 18, 2016Go to PortlandParks.org, click on the Register Now tab.

• Adaptive Skate Camp... see page 5• Bowling... see page 4• Trips... see pages 8-12

2 Adaptive and Inclusive Recreation 503.823.4333

EQUITY GOAL #2

EQUITY GOAL #3

Register online at portlandparks.org 3

Portland Parks & Recreation

Hours: Monday through Friday, 9:00am-5:00pmClosed: May 30 – Memorial Day

Rec. Coordinator II: Jane Doyle E-mail: [email protected]. Coordinator I: Dawn HubbardE-mail: [email protected]. Leader: Madeline JonesE-mail: [email protected]

Bus Line: # 72MAX Lines: Yellow line

Parking: Accessible in parking lot.

Disabled Access: Entrances: Accessible Parking: Accessible

Within the Americans with Disability Act (ADA) of 1990, Portland Parks & Recreation (PP&R) provides accommodations to individuals with disabilities/special needs, so that they may receive an equal opportunity to participate in programs offered citywide.

How it Works1. Choose the activity you would like to participate

in, and then access the PP&R site to know where the activity is being offered.

2. Register for the activity. You can do this in person at a PP&R site, or online at

portlandparks.org. When registering, let the person know you will need accommodations in order to participate in the activity (online, check the box.)

3. Once registered, please contact Inclusion Services at 503-823-4333. If this is your first accommodation through Inclusion Services, you will need to do a phone intake with a staff member. At the end of the phone intake, it will be determined whether an assistant will be needed on the first day of the activity to provide on-site support. Future assistance will be provided based on need. The inclusion staff will work with the instructor on how to support you and your individual needs.

Important DetailsA general program may be adapted using auxiliary aids and services, but the basic structure of the program remains the same. Accommodations are made as needed, and can be flexible as well as creative. Participants need to register for activities that are intended for their birth age. Personal care is provided for activities in the pre-school and youth category, up through age 12.

If you have questions about Inclusion Services, please call 503-823-4333 or 711 (TRS). A minimum of 10 business days (Monday-Friday) advance notice is required. The Inclusion Services staff will do their best to accommodate each participant.

INCLUSION SERVICES FOR PEOPLEWITH SPECIAL NEEDS

View and register for classes on-line at portlandparks.org or call the

Customer Service Center at 503-823-2525.Fall 2016August 15

Summer 2016April 18

CALENDAR

Adaptive and

Inclusive Recreation (AIR)

5340 N Interstate Ave.Portland, OR 97217

Telephone: 503-823-4333FAX 503- 823-4329Oregon Relay - 711

TABLE OF CONTENTSInclusion Services ................................................. 3Drop-in Classes ..................................................... 4Camps ................................................................... 5Teen Classes .......................................................... 6Adult Classes .....................................................6-7Friends, Food, & Fun ............................................ 7Adult Outings ...................................................8-12Summer Free For All Activities .....................13-15Citywide Activities .........................................16-19Registration Information ................................20-21

Portland Parks & Recreation

4 Adaptive and Inclusive Recreation 503.823.4333

Bowling For Fun age: 10 - adultHave fun with your friends while knocking down pins. Beginners to advanced bowlers are welcomed. Bring $5 for one game or $10 for two. To accommodate bowlers who wish to play every week and don’t want to hassle with bringing money each time, we offer a 20 game punch card for $100.Shoes are free. Pre-registration is not required. Adaptive bowling equipment is available at the lanes. This is a drop-in activity.Date: Wednesdays July 6 - September 28Time: 3:00pm - 4:30pmCost: $5 per game

DROP-IN CLASSES

Mt. Scott Community Center5530 SE 72nd

(four blocks south of Foster Blvd.)Bus #10 and #14

Cost - $5Age 16 - Adult

1st Friday of the month

June 3rd - Elvis

Have fun dancing to a DJ or a band. Socialize with friends, both new and old. Refreshments are provided. Cost for participants is $5. Facility staff and parents get in free, but donations are kindly accepted to help with the cost. Group and foster

home staff must stay to assist their participants in the dance unless prior arrangements have been

made with AIR by calling 503-823-4333.

Due to the large number of participants who attend the dance, AIR staff is only able to supervise

participants who are in the auditorium, social room or the hallway of the center. Staff is unable to

provide assistance to participants who need close supervision or personal care in the restroom.

Register online at portlandparks.org 5

Portland Parks & Recreation

Register

Now!

ADAPTIVE CAMPS

Teen Explorer Campages 13-22

This exploratory day camp is designed for teens with special needs. Every day is a different outdoor adventure around the metropolitan area. Participants will explore nature along accessible trails in Portland’s Parks & Natural Areas. Activities include games, crafts, and stewardship possibilities. Contact the Adaptive and Inclusive Recreation Office at 503-823-4333 for more information.

Course #: 1045442Dates: August 15 - 19Time: 9:00am - 3:00pm Cost: $150Meet: Interstate Firehouse 5340 N Interstate

SkateboardingAdaptive Skateboarding Camp ages 7-12Set & reach new skateboarding goals while building healthy confidence on your board! This camp provides recreational opportunities for youth with disabilities, siblings and friends. Learn about skate park etiquette, safety practices, & skateboarding fundamentals. Improve balance, mechanics, riding skills & control. Get up, get excited! Let’s skate!Course #: 1047631Location: Glenhaven Park - Skate Park 1Dates: Monday - Friday June 27 - July 1Time: 9:00am - 12:00pmCost: $60Course #: 1045880Location: Glenhaven Park - Skate Park 1Dates: Monday - Friday July 25 - 29Time: 9:00am - 12:00pmCost: $60Course #: 1045887Location: Sellwood Park - Tennis Court 1 ADates: Monday - Friday August 15 - 19Time: 9:00am - 12:00pmCost: $60

Portland Parks & Recreation

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SEPTEMBER CLASSES

TEENS ADULTS

TEENS & ADULTS

Strength & MovementDesigned so almost anyone can participate. Gently works muscles & joints to enhance strength, range of motion, balance & circulation. Feel relaxed, refreshed & re-energized.Instructor: Carolyn BochLocation: East Portland Community Center 740 SE 106thCourse #: 1048741Dates: Tuesday September 6 - 20Time: 4:15pm - 5:15pmCost: $21

Cooking with FriendsOne part food, two parts pals create the formula for a good tasting event. Gain confidence & cooperative skills while discovering new recipes & preparing a wonderful dish to share. Smile while enjoying the fruits of your labor.Instructor: Madeline JonesLocation: Alice Ott SUN Community School 12500 SE RamonaCourse #: 1048745Dates: Thursdays September 8 - 29Time: 5:30pm - 7:00pmCost: $40

Hip Hop: BasicsFeel the heat! Catch the groove & capture the irresistible beat! Adaptive class to work on technique, turns, combinations & complete dances. Increase agility & coordination while experiencing a beat that has you moving your feet!Instructor: D.J. HawkeLocation: Interstate Firehouse Cultural Center 5340 N InterstateCourse #: 1048742Dates: Monday September 12 - 26Time: 6:30pm - 7:30pmCost: $24

Drum Circle Feel the Beat! Be creative, and stomp your feet. Discover drumming methods & making up beats on the spot. Appreciate the role rhythm plays and explore drumming together. Catch the rhythm and hear the beat! We meet once a month!Instructor: Connie HillLocation: Interstate Firehouse Cultural Center 5340 N InterstateCourse #: 1045922Dates: Tuesdays April 12, May 10 & June 14Time: 5:30pm - 6:30pmCost: $18

Register online at portlandparks.org 7

SOCIAL SAMPLER

Portland Parks & Recreation

Portland Parks & Recreation

8 Adaptive and Inclusive Recreation 503.823.4333

FRIDAY & SATURDAY ADVENTURES AGE: 18 & UP

Friday!Dinner & DancingFriday night Dance Party! Meet new people & dance at Vancouver Park & Recreation, Access to Recreation Dance. Dine out and enjoy dinner before moving to the music! Bring $7 for admission into the dance and dinner.Course #: 1049918Instructor: Richard RiessDate: Friday July 8Time: 4:00pm - 8:30pmCost: $25

Bonneville Fish Hatchery & DamDid you know that the sturgeon is a “prehistoric” fish and appeared millions of years ago in the Jurassic period? Come check out the fish hatchery as we walk around learning new things. After a sack lunch we will be off to visit the Bonneville Dam, seeing fish jumping over the fish ladders, learn history & see boats go through the locks. Bring a sack lunch and $15 for spending money & ice cream.Course #: 1050973Date: Saturday July 9Time: 9:00am - 3:30pmCost: $35

TRIPSJuly 8th Dinner & Dancing 9th Fish Hatchery & Picnic Lunch 14th Hillsboro Hops Baseball Game 16th *Beach Trip: Fort Stevens Battery Russell 21st Willamette River Jet Boat Ride 23rd Catch The Big One! 28th Fun At The County Fair 30th Portland Thorns Game

August 4th Columbia Gorge Sternwheeler 6th Coastal Primate Sanctuary 11th A Thrilling Day At Oaks Park 13th *Oregon Coast Scenic Railroad 18th BBQ Lunch & Movie at Interstate Firehouse 20th Exploring The Oregon Zoo!

September 3rd *Old McDonald’s Farm 10th *Whale Watching 17th Big AL’s 24th Wolf Haven

Join us on a Van Excursion!

Register online at portlandparks.org 9

Portland Parks & Recreation

Hillsboro Hops Baseball GameCome join us to cheer on the Hillsboro Hops while they take on the Spokane Indians. Hillsboro’s newest Minor league baseball team. Bring money for lunch. Bring $16 for ticket & $ 15 for dinnerCourse #: 1048733Date: Thursday July 14Time: 5:45pm - 10:45pmCost: $28

THURSDAY & SATURDAY ADVENTURES AGE: 18 & UP

Willamette River Jet Boat RideTravel at a high speed with the wind flying through your hair. Feel the spray of the water as you travel through the city, having a wonderful day. This is a way to see the sights differently. Learn about the history of the area that we live in. Bring $31 for the Jet boats and $10 for lunch. Course #: 1048734Date: Thursday July 21Time: 3:30pm - 8:30pmCost: $28

Catch The Big One!Do you like fresh trout? Experience the sensation of catching & eating your own dinner. Improve fishing skills & hook a ‘whopper’ from a stocked pond located in a natural setting. Imagine the fun you’ll have sharing personal fish stories that will surprise friends & family. Bring a sack lunch and $20 for fish cleaning.Course #: 1048735Date: Saturday July 23Time: 10:00am - 4:00pmCost: $30

New van trips departure location: Interstate Fire house5340 N Interstate Ave

Max Line: YellowBus Number: #72

*Day at the BeachSpend the after in the sand and exploring Fort Stevens in Warrington, Or., while making new friends. Join us for a picnic lunch at Coffenbury Lake, followed by an afternoon playing in the sand. Next stop will be at Battery Russell. Explore this old Battery used in World War II. This is a non-accessible trip. Bring $5 for ice cream on the way home.Course #: 1049923Date: Saturday July 16Time: 9:00am - 6:00pmCost: $45

Portland Parks & Recreation

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Fun At The County FairEscape from the ordinary with an unforgettable ‘down home’ experience. Develop a life-long love for an old-fashioned American tradition. From farm animals & crafts to games & rides, nothing compares to the scents, sounds & memories you’ll remember for years! Bring $10 for lunch at Burgerville and money for spending at the fair.Course #: 1048736Date: Thursday July 28Time: 10:30am - 5:00pmCost: $34

Portland Thorns GameCome cheer on the Portland Thorns as the play against the Seattle Reign. This will be an exciting day to make new friends, yell loudly as we support our team. Bring $20 for dinner. We will be meeting at Providence Park 1844 SW Morrison, by the face. Price of trip includes the ticket to the game.Course #: 1050827Date: Saturday July 30Time: 6:45pm - 10:45pmCost: $52

Columbia Gorge SternwheelerBoard from Marine Park at Cascade Locks, in the heart of the Columbia River Gorge National Scenic Area. Enjoy a riverboat cruise on an authentic triple-deck paddle wheeler, providing 360 degrees of breathtaking vistas. Step on board for a unique afternoon on the river. Fee includes cruise, non-refundable after 6/30. Bring $15 for box lunch and $5 for ice cream afterwards.Course #: 1050905Date: Thursday August 4Time: 9:15am - 3:15pmCost: $64

Coastal Primate SanctuaryCome explore the beautiful 28 acre sanctuary where the monkey’s live amongst the trees, birds and deer. Their mission is to take in unwanted monkey’s that need a place to stay and provide life time care. Bring a sack lunch and $10 cash for admission.Course #: 1048732Date: Saturday August 6Time: 9:00am - 2:00pmCost: $28

A Thrilling Day At Oaks ParkWhat is your favorite amusement attraction? Hang on tight as you spin, dip & roll your way to adventure. Develop friendships & a lifelong love for excitement, sure to create great memories & put a smile on your face. Bring a sack lunch and $10 for a ride bracelet.Course #: 1048739Date: Thursday August 11Time: 11:15am - 4:00pmCost: $26

THURSDAY & SATURDAY ADVENTURES AGE: 18 & UP

Register online at portlandparks.org 11

Portland Parks & Recreation

THURSDAY & SATURDAY ADVENTURES AGE: 18 & UP

*Oregon Coast Scenic RailroadJoin us on a train ride between Garibaldi and Rockaway Beach and back. This train goes along the Tillamook Bay with views of many different types of wildlife. Afterwards we will be stopping for ice cream. Please bring $20 for the train ticket and $5 for ice cream afterwards. Please bring a sack lunch to eat at a Bayside ark in Garibaldi. The train is not accessible.Course #: 1048737Date: Saturday August 13Time: 9:15am - 6:30pmCost: $45

BBQ Lunch & Movie at Interstate FirehouseSpend the day with new and old friends. Watch as we BBQ your burger on the grill, in Patton Park. Play some games in the park. We will go inside to enjoy a movie in our theater. Price of trip includes your BBQ’d lunch and the movie, followed by and ice cream treat. Meet at the Theater.Course #: 1048738Date: Thursday August 18Time: 11:30am - 3:30pmCost: $35

It’s Happening At The Oregon Zoo!Sea lions & otters romp for your enjoyment in underwater viewing areas! Insects, amphibians, birds & mammals await your discovery! Explore different environments, including tundra, desert & marine life gaining knowledge of animals from around the world. Bring $ 26.50 for lunch & admission. Meet in the Lobby.Course #: 1050974Date: Saturday August 20Time: 8:30am - 2:30pmCost: $32

Scholarships: City of Portland residents and non-residents, regardless of age, who require financial assistance can apply for partial scholarships for AIR activities. Contact AIR at 503-823-4333.

*Old McDonald’s FarmAdventure out to the farm as we learn how to feed all types of livestock. Spend the morning with chickens, pigs, goat, horses and cows in their own farm habitat. Bring $20 for admission and lunch. This is a non- accessible trip. Meet in the Lobby.Course #: 1050981Date: Saturday September 3Time: 8:45am - 2:00pmCost: $30

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*Whale WatchingJoin us on The Samson, a fifty foot wheelchair accessible vessel. As we board we will be greeted by Lars and the deck hand James, who will make us feel like a part of the crew and right at home as we adventure out on our 1 hour trip to look for whales. This trip is weather dependent. Bring snacks, jacket and $35 for the excursion and lunch. Meet in the Lobby.Course #: 1050985Date: Saturday September 10Time: 8:15am - 6:00pmCost: $50

THURSDAY & SATURDAY ADVENTURES AGE: 18 & UP

Big AL’sGames! Games! Games! There is a lot to do on your day at the arcade. Try to beat your score on your choice of games. Cheer your friends on or try something new! Bring $15 for lunch and $15 for games. Meet in the Lobby.Course #: 1050990Date: Saturday September 17Time: 10:30am - 2:30pmCost: $25

Wolf HavenThe sanctuary in Tenino, WA has provided rescue for displaced, captive-born wolves, a few coyotes, foxes & wolf-dog hybrids. They promote wolf restoration & educate the public about the value of all wildlife. Tour the outdoor animal living areas & grounds. This is a 1 hour walking tour on hard packed gravel, followed by an indoor movie “World of Wolves”. Bring a snack, $15 for lunch at Don Juan’s Mexican Restaurant. Trip fees includes admission. Dress for weather. Meet in the Lobby.Course #: 1050991Date: Saturday September 24Time: 9:00am - 5:45pmCost: $56

WITHDRAWAL & REFUND INFORMATIONWITHDRAWALS & REFUNDS: Please notify us at least seven (7) days, unless otherwise specified, before the start of your program so that we can refund or credit your account for the registration fee. Pre-paid materials and admission tickets cannot be refunded. Participants needing to withdraw after the program has begun are offered a prorated credit or refund based upon when the request is made.

MONDAYS

TUESDAYS

WEDNESDAYS

WEDNESDAYS

THURSDAYS

FRIDAYS

DATE

DATE

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Portland Parks & Recreation

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Reg

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nREGISTRATIONReceipt of full payment is required for registration, unless otherwise arranged. Please call if you receive a returned check or declined bank card notice, either of which void registration.

RESIDENT / NON-RESIDENTA resident is:

• anyone who occupies a permanent residence inside the city limits of Portland. At the discretion of a Community Center Director, proof of home address may be required. Acceptable address verification may include a 1) drivers license, 2) Oregon ID card, 3) property tax statement, 4) utility bill or lease agreement with current home address.

• any child living within the school boundaries of the Reynolds and Centennial School Districts who is attending a SUN Community School. Through a partnership between the City and County, a child attending a SUN Community School is eligible to register for programs at any SUN Community School location without paying a non-resident surcharge.

Anyone else is considered a non-resident (NR) and will be assessed a 40% surcharge (rounded to the next highest quarter (.25)). NR surcharges do not apply to drop-in activities. Non-residents who wish to register for PP&R activities may choose one of these options:

• Pay the additional 40% NR fee.

• Purchase a NR fee discount pass as either an individual or family for a period of three, six or nine months from the date of purchase. The NR discount pass takes 25% off the NR fee for the activity. Inquire about this option at time of registration. These passes are not refundable.

Non-resident Pass Prices

3-month pass: Individual $25 Family $50

6-month pass: Individual $45 Family $90

9-month pass: Individual $65 Family $130

A family denotes a couple (married or domestic) or a single parent and their legal dependents living in the same residence.

CLASS ENROLLMENTOur classes must meet minimum and maximum enrollment standards. Classes may fill quickly or be canceled due to low enrollment.

WITHDRAWAL & REFUNDSPlease notify us at least seven (7) days, unless otherwise specified, before the start of your program so that we can refund or credit your account for the registration fee. Pre-paid materials and admission tickets cannot be refunded. Participants needing to withdraw after the program has begun are offered a prorated credit or refund based upon when the request is made.

SCHOLARSHIPSCity of Portland residents, regardless of age, who require financial assistance may apply for partial scholarships. Contact individual centers for information.

NOTICE OF NON-DISCRIMINATIONPP&R programs and services reflect the cultural diversity of our community. We do not discriminate on the basis of religion, race, color, gender, national origin, sexual orientation, age or ability.

SPECIAL NEEDSWithin the American with Disability Act (ADA), a person with a disability or special need who desires assistance with registration and/or participation in general PP&R programs can contact Inclusion Services at please call 503-823-4333 or 711 (TRS). If you request assistance through Inclusion Services, a minimum of 10 business days (Monday-Friday) advance notice is required.

If you need a sign language interpreter or FM loop amplifier, please contact please call 503-823-4333 or 711 (TRS), at least five business days in advance of the activity or class. Information about programs and services is available online for those needing a voice synthesis; visit our website at www.PortlandParks.org. For additional ADA information, call 503-823-2223.

PHOTO POLICYPortland Parks & Recreation (PP&R) reserves the right, and may give permission to the media, to photograph classes, programs, and participants at any of our facilities and properties or any sponsored activity. Please be aware that these photos are for promotional purposes and may be used in future publications and media communications in any format.

If you do not wish to be photographed, please inform staff and we will make reasonable efforts to honor your request. If you see staff taking pictures, and you do not wish to be photographed, please let us know.

If you see a photo of yourself or a family member that causes you concern, please notify us. As a courtesy, we will make every reasonable effort to dispose of the image, and will not use it in future publications. However, we will not be able to retrieve, destroy or discontinue existing printed publications in which the photograph may have been included.

CUSTOMER SATISFACTIONYour satisfaction is our goal! Portland Parks & Recreation strives for 100% customer satisfaction. If you are not satisfied with a recreation program or service, please let us know.

INFORMATION HOTLINEFor information on other PP&R services & programs, call our Information Hotline at 503-823-PLAY (7529), Monday-Friday, 8:30am-5pm.

INCLEMENT WEATHERIf the City of Portland public school districts (Portland Public, Parkrose, David Douglas, Reynolds, and Centennial) are closed because of weather conditions, PP&R classes and youth basketball in those school districts are cancelled. However, some sites may be open for drop-in activities. Call the specific PP&R facility for information and opening/closing times. If inclement weather is forecast on weekends or holidays, call the PP&R facility or program for operating hours and activity cancellations.

Registration Inform

ationRegister Now – One of Five Ways

CHECK ONE: New Customer Taken class with PP&R before My account information has changed

Main Contact Name _______________________________________________________________________ Birthdate ___________________________ M_____ F_____

CIRCLE ONE: AfricanImmigrant AmericanIndian/AlaskaNative Black/AfricanAmerican Hispanic/Latino NativeHawaiian/PacificIslander White Slavic/Eastern European Immigrant Asian Multi-Racial Other

Home Address ________________________________________________________________________ City/St/Zip _______________________________________________

Home Phone (_________)________________________________________________ Work Phone (_________)_________________________________________________ Cell Phone (_________)_____________________________________________ Email Address _______________________________________________________________

Emergency Contact Name & Phone Number ___________________________________________________________________________________________________

Portland Parks & Recreation welcomes individuals with disabilities and special needs into programs. Please describe any accommodations needed for successful inclusion: _____________________________________________________________________________________________

Name(last,first) Birthdate M/F Class Title Course # Class Location Start Date Cost

PARTICIPANT INFORMATION

ONLINE at PortlandParks.org – Click on the “Register Now!” top tab. Search for classes by age, category, location or keyword – or narrow your search by specific activity or course number.

PHONE – Complete this registration form and call any PP&R site using the phone numbers on the map pages. You may also phone in your registration to the PP&R Customer Service Hotline at 503-823-2525, Monday-Friday, 8:30am-5:15pm. Only Visa, MasterCard or American Express accepted with phone-in registration.

MAIL – Mail your completed registration form to the program center address. Include full payment using your Visa, MasterCard, American Express or check payable to the City of Portland. Mail-in registration is also received at the PP&R Customer Service Center, 1120 SW Fifth Ave, Suite 1302, Portland, OR 97204.

FAX – Complete the registration form and fax it to 503-823-2515 with full payment using your Visa, MasterCard or American Express. Faxes are accepted 24 hours a day, seven days a week, but are processed during regular business hours.

IN PERSON – Any PP&R facility is able to process your registration, including the Customer Service Center located in the lobby of the Portland Building at 1120 SW Fifth Ave. All Community Centers are open for walk-in registration during business hours.

NON-RESIDENTS of the City of Portland pay a 40% surcharge. Or you may purchase a non-resident pass at the amounts listed below. List pass price or 40% surcharge in column at right and add to your total.

I already have a non-resident pass. Duration ______-month Purchase date ______/______/______

Passholder name ________________________________________________________________________________________________

I need a pass. Circle one: 3-month | 6-month | 9-month Circle one: Individual | Family

Name of person(s) needing pass ______________________________________________________________________________

3-month pass: individual $25; family $50 | 6-month pass: individual $45; family $909-month pass: individual $65; family $130

I do not want a pass. I choose to pay the 40% surcharge.

Subtotal

40% non-resident surcharge or

pass price

TOTAL

Please print

CHECK Check number_____________________ (make check payable to the City of Portland)

CREDIT CARD Information

Account # ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ Expires ____________________________________

Cardholder’s Name_____________________________________________________ Signature______________________________________________________________

PAYMENT INFORMATION

VISA

MasterCard

Amex

Adaptive and Inclusive Recreation5340 N Interstate Ave.Portland, OR 97217