The City of Belmont's Parks and Recreation Department encourages persons with disabilities to participate in our programs and events. We will make reasonable efforts to accommodate persons with disabilities in accordance with the Americans with Disabilities Act (ADA).

 

If you or your child require reasonable accommodations, please submit this form at least 21 days in advance of the program, event, or activity. Requests received after this deadline will be subject to availability. 

1

Name of person completing form 

 *

Name of person completing form

2

Contact e-mail 

 *

Contact e-mail

3

Contact phone number

 *

Contact phone number

4

Name of person needing accommodation(s)

 *

Name of person needing accommodation(s)

5

Please list the name of the program, class, activity, or event that you are requesting the accommodation for. 

 *

Please list the name of the program, class, activity, or event that you are requesting the accommodation for.

6

Please describe the accommodation request.

 *

Please describe the accommodation request.

7

What is the duration of the request? 

 *

What is the duration of the request?

Permanent

Temporary If other, type text here.

8

Please provide any additional information that might be helpful to us in evaluating the request. 

Please provide any additional information that might be helpful to us in evaluating the request.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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