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ADA Reasonable Accommodation Request Form
The Town of Groton Parks and Recreation welcomes the participation of all abilities. We are committed to compliance with the ADA and provide reasonable accommodations.
Date of submittal
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MM
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DD
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Name of program, service or activity you are requesting an accommodation.
Start Date of Program
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Reason for request
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Participant Name
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First
Last
Email
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Phone
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Name of person requestiing the accomodation
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Preferred Accommodation options (please list all possible; be specific as possible
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Alternative Accommodation options (please list all possible; be specific as possible
*
Signature of participant, parent or guardian
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