Recreation Assessment Programs only (not camp)
This assessment helps us get to know you/your child/adult better. We want everyone to be successful in all of our programs. The more information we have, the better chance of success. All information you provide is confidential and will be shared with only the staff involved in the program.
If a question is not applicable, please check n/a

Please feel free to call or email me me to discuss you/your child's needs. Eileen 860-536-5691 ecicchese@groton-ct.gov.

If something doesn't not apply, put N/A not applicable.
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  • Medical Information

  • Swimming

  • Mobility

  • Behavior/Personality

  • Social

  • Cognitive

  • Personal Care

  • Safety

  • Authorization to Contact and Release of Information

    Unless otherwise indicated, I grant permission to Groton Parks and Recreation to contact the school, teachers assistant, teacher, social workers, therapist or physician for the purpose of gathering or releasing information regarding this participant. The information will be used to provide the most effective plan for providing recreation services and proper placement in inclusion. All information will be kept confidential.