Recreation Program Support Application

Recreation Support Program Application

1. Applicant Information

2. Parent/Caregivier/Guardian Information

Address:
City
Province
Postal

3. Recreation Program(s) Registered

(i.e. Swim Kids 1)
(i.e. 21881)
:
:
(i.e. Hyde Creek)
Please Note: Complete section 4 & 5 if you’re a NEW participant or if it’s been more than 6 months since your last Leisure Buddy request. Returning Leisure Buddy request will need to complete sections 1, 2, 3 & 6.

Please take the time to thoroughly complete this form. Providing us with as much information as possible assists us in delivering a positive experience for all participants and staff.
Please remember what may be routine for your family may be out of the ordinary for our program leaders.

Recreation Program Support Roles & Responsibilities

Program leaders lead activities and respond to all matters relative to health and safety of all staff and children in the program. The Recreation Support Program provides support for children/ youth in registered activities. Recreation Staff collaborate with families to provide strategies and adaptations to build a positive experience for children and youth, such as:

  • Assisting participant with focusing on task (re-direction)
  • Encouraging participant to engage in activities
  • Providing additional instructions or reinforcement during activities

We are unable to provide personal care such as assistance with toileting, administering medication and changing. If program support is not available, Access and Inclusion will discuss further options and strategies.

Behaviour and Communication

Please take the time to complete section 5 to provide us with as much information as possible to assist us in delivering a positive experience for all participants and staff. Remember what may be routine for your family may be out of the ordinary for our program leaders.
Behaviours (select all that apply)
Which is the most effective for the participant’s learning (select all that apply)

Recreation Program Expectations

To provide a safe and welcoming environment we ask all participants and their families and staff to follow the Caring Code:

- Take Care of Yourself                 - Take Care of Others                    - Take Care of this Place

Example of Violations:

-  Kicking/hitting others               - When health/safety of participant/staff/ volunteers are impacted

- Leaving space without consent              - Damages to facility/ equipment

- Using inappropriate languages and behaviour to staff/others

I understand it is my responsibility as the parent/guardian/caregiver/ that the above information on this application is true and correct to the best of my knowledge and understand Port Coquitlam’s Recreation Program Support Roles and Responsibilities.
Name
Name
First
Last
Personal information entered on this form is collected under the authority of section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA), and will be used to assess your application. If you have any questions or concerns about how your information will be used, contact the City’s Records and FOIPPA Administrator at 604.927.5250 or corporateoffice@portcoquitlam.ca
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