Online. Click "Register online" in the menu on NISRA's Home page atwww.nisra.org. It's easy! If you need help creating your account, leave amessage at 815-459-0737 and we'll return your call.

Mail or drop-off. Use the form at the end of this brochure to mail or dropoff a paper registration in the drop box at the NISRA Office.Fax. 815-459-0388If you already registered for Summer, you will get credits for the Juneprograms that we would have had in-person. You do not need to completeanother registration form or waivers when adding these virtual programsto the existing summer programs in your account. Leave a phone messageat 815-459-0737 if you are adding these programs to the summer programsyou already registered for.

How to Register

Our spring virtual programs were a success! Here are more programswhere you can connect with NISRA staff and your friends online. Virtual programs listed in this brochure take place from June 1- June27. These will fill a gap until we have more information about possibleprograms in July. Credits will be issued for June programs that can'ttake place in-person due to COVID-19.

Visit www.nisra.org, Facebook, Instagram for more activities

NISRA VIRTUAL PROGRAMSJUNE 2020

Registration Deadline:May 25

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NISRA VIRTUAL PROGRAMSAdditional program and registration information R/NR Fee. Indicates Resident or Non-Resident of NISRA's 13 Member Districts.NISRA's 13 Member Districts (residents of the member districts qualify for theResident Fee):

Some programs have slightly higher fees due to supplies and/or the expertiseof the specialty leader. Some programs have maximums because supplies are included. If you register for a program with supplies, you will receive an email withinstructions about getting the supplies. We will have a few different optionsof dates, times and locations to obtain supplies, and we can make additionalaccommodations so that everyone who registers will receive the supplies.

Registration Deadline:May 25

Please register by the May 25 deadline so we can distribute supplies,communicate with specialty leaders, and prepare for a fantastic experience!Refer to the regular Summer brochure on NISRA's website for NISRA'sstandard policies about payments, billing, and program information (pages45-53). Questions about details of any of these programs? Please email Cyndi atcherendeen@nisra.org. Please do not email registration to Cyndi.

Barrington Park District Cary Park DistrictCrystal Lake Park DistrictDundee Township Park DistrictCity of ElginHampshire Township Park DistrictCity of HarvardHuntley Park DistrictVillage of Lake in the HillsMarengo Park DistrictCity of McHenryWauconda Park DistrictCity of Woodstock

MONDAYS - JUNE 1-JUNE 22

5:30-6:30 pm: VIRTUAL #5005 - Trivia Tuesdays Adults

Test your knowledge of all kinds of trivia! Each week will be adifferent intriguing category. R/NR Fee $10/$14

6:00-7:00 pm: VIRTUAL #5006 - Good News Groupies

TeensIt's a great day for some good news! Come share your positivestories and thoughts with friends.R/NR Fee $10/$14

5:00-6:00 pm: VIRTUAL #5002 - How'd Ya Make That? Teens & Adults

Any Pinterest fans? Craft some DIY (do it yourself)masterpieces! *Instructions for supply pick-up will be emailed toyou.R/NR Fee $18/$23 Maximum participants: 15

6:00-7:00 pm: VIRTUAL #5018 - Game DayTeensLet's play some favorites like Hangman, Bingo, Simon Says,Yahtzee and more--in a whole new creative way online! Join us forsome friendly competition.R/NR Fee $10/$14

6:30-7:15 pm: VIRTUAL #5003 - Relaxation Yoga-Mat & Chair

Teens & AdultsInstructor Denise is back to help you enjoy this gentle yogapractice and increase your mindfulness techniques. You canparticipate on the floor or use a chair. Relax!R/NR Fee $28/$37

TUESDAYS - JUNE 2-JUNE 23

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WEDNESDAYS - JUNE 3-JUNE 24

5:00-6:00 pm: VIRTUAL #5010 - Social Butterflies Youth

Grab your favorite snack and chat with NISRA Staff and friends.R/NR Fee $10/$14

6:30-7:30 pm: VIRTUAL #5011 - Theater TroupeTeens & AdultsJoin in on NISRA's theater fun! Practice acting skills, step-by-stepchoreography and sing-a-long to Broadway favorites.R/NR Fee $10/$14

7:00-7:45 pm: VIRTUAL #5012 - ZumbaTeens & AdultsWe can't be together in-person, but you can still have a high-energy, fun-filled Zumba session with Silvia!R/NR Fee $28/$37

1:00-2:00 pm: VIRTUAL #5008 - What's Up Wednesdays Youth

Got the mid-week jitters? Get ready to move, groove, shake andhop around with your friends!R/NR Fee $10/$14

3:00-4:00 pm: VIRTUAL #5009 - Playful Pets

All agesHang out with your friends, learn about animals, and how to carefor pets in this PAWSitively awesome program. All pets welcome,so feel free to bring your FURever friend! R/NR Fee $10/$14

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THURSDAYS - JUNE 4-JUNE 25 10:00-10:30 am: VIRTUAL #5014 - Rhythm Works Integrative Dance

Ages 8-14Dance instructor Courtney Garcia of Integrity Dance Studio leadsyou through foundational & fun dance steps to build your self-esteem and independence. All abilities welcome, let’s celebrateour diversity! R/NR Fee $34/$45

10:45-11:15 am: VIRTUAL #5015 - Rhythm and Moves Dance

Ages 15 & olderDance instructor Courtney Garcia of Integrity Dance Studio usesfun & functional dance steps that mimic everyday life! Some havea hip hop flare, but the movements can be adjusted to any style.R/NR Fee $34/$45

4:00-5:00 pm: VIRTUAL #5016 - Group KaraokeAll agesKaraoke in a Zoom session is fun and hilarious! If you enjoysinging and listening to others sing, give this a try!R/NR Fee $10/$14

6:00-7:00 pm: VIRTUAL #5017 - Art Explorations

Teens & AdultsUsing only watercolor crayons, learn art techniques fromtalented Instructor Mary Telfer! *Instructions for supply pick-upwill be emailed to you.R/NR Fee $27/$35 Maximum participants: 10

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6:30-7:15 pm: VIRTUAL #5019 - Encore! Joyful Noise Choir Teens & Adults

Harmonize with Encore! Music Academy's Steve! Belt out sometunes & sing away the blues in a fun Zoom session since we can'tbe together in person. R/NR Fee $10/$14

5:00-6:00 pm: VIRTUAL #5020 - Crafty Creations Youth

Spend time creating new projects. In four weeks we'll use a varietyof supplies to design a collection of art work! *Instructions forsupply pick-up will be emailed to you.R/NR Fee $18/$23 Maximum participants: 15

5:15-6:15 pm: VIRTUAL #5022 - Fitness Fridays

All agesNeed some motivation? Stop by for an energizing workout that’ssure to end your week strong!R/NR Fee $10/$14

6:00-7:00 pm: VIRTUAL #5021 - Instagram 101

TeensNeed help getting your account started? Explore the basics ofInstagram and get engaged with NISRA. Prerequisite: basiccomputer knowledge. NISRA staff will provide a PowerPointpresentation prior to the program.Fridays for only 2 weeks: June 5 and June 19R/NR Fee $10/$14

FRIDAYS - JUNE 5-JUNE 26

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SATURDAYS - JUNE 6-JUNE 27 10:00-11:00 am: VIRTUAL #5023 - Weekend Warriors

Youth & TeensStart your Saturday off right! Spend some time with your friendsand NISRA staff. We will play a variety of games, guide you in somecrafts, socialize, and more! *Instructions for supply pick-up will beemailed to you. R/NR Fee $13/$17 Maximum participants: 15

2:00-2:45 pm: VIRTUAL #5024 - Special Focus Karate

Beginners, All ages*this program replaces on-site Karate at Focus Martial Arts sincewe can't gather in person. Learn basic skills & grow in confidence.R/NR Fee $32/$42 Maximum participants: 25

SPECIAL EVENTS6:15-6:45 pm: VIRTUAL #5026 - Get Glam for Prom

Teens & AdultsGet ready for a night of fun at our NISRA Virtual Prom by hangingwith the girls! We'll do a quick makeup lesson to look glamorous foryour big night! Saturday, June 13R/NR Fee $ Free! Maximum participants: 15

7:00-8:30 pm: VIRTUAL #5027 - Prom

Teens & AdultsAll dressed up with nowhere to go? DJ Ray will broadcast yourfavorite songs so we can dance the night away. Create a completelynew memory at NISRA's first-ever virtual prom! We can't wait to seeyou dressed up in formal attire. *Instructions for pick-up of agiveaway item we have for you will be emailed to you.Saturday, June 13R/NR Fee $15/$19 Maximum participants: 30

6:00-7:30 pm: VIRTUAL #5025 - Luau Party

AdultsItching for a vacation? Come escape to a virtual tropical locationand hang loose while we engage in luau activities. *Instructions forsupply pick-up will be emailed to you.Saturday, June 20R/NR Fee $10/$14 Maximum participants: 30

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Participant’s InformationLast Name______________________________________ First Name___________________________________ Address _______________________________________ City ______________________________ Zip ________Birthdate __________ Age ____ Gender: ___Female ___Male ___Other School _____________________________________ School District ____________________ Teacher ____________________Employer/Service Provider___________________________ Caseworker _____________________ Phone ( )_______________Primary Disability______________________________ Secondary Disability _____________________________________Down syndrome? Yes No If yes, checked for Atlanto-Axial Subluxation Condition? _____ Date Condition cleared? ________Seizures? Yes No If new & no Seizure Questionaire on file w/NISRA, please complete form in this brochure & return w/registration.

Please turn this page to complete the program registration and sign the waiver.

Both sides of this form must be completed, signed and returned, WITH FULL PAYMENT, to the NISRA Office before registration will be processed and the participant will be allowed to attend any program. Refer to registration information on Page 48 of the brochure online at www.nisra.org

If the participant is an adult, does he or she have his or her own legal guardian status? Yes No

Primary Contact Information – person who should be contacted FIRSTLast Name________________________________ First Name____________________________ Relationship___________________Email address (please print)_____________________________________________________ • Primary Phone ( )______________________ # called FIRST with program changes, automated messages, and for staff to have at the program• Alternate Phone ( )_______________________ • Work Phone ( )______________________

Alternate Contact Information (Fill out ONLY if it is appropriate for this person to be contacted, if the Primary Contact cannot be reached)Last Name________________________________ First Name____________________________ Relationship___________________Email address (please print)_____________________________________________________ • Primary Phone ( )______________________ • Alternate Phone ( )_______________________ • Work Phone ( )______________________

Group Home Name________________________ Group Home Contact Name__________________ Phone ( )____________ Email address_______________________________

Emergency Contact–Please give the name of a relative or friend who can respond in case of emergency when you cannot be reached.Last Name________________________________ First Name___________________________ Relationship____________________Home Phone ( )_________________________ Cell Phone ( )_____________________ Work Phone ( )_______________

Alternate Emergency ContactLast Name________________________________ First Name___________________________ Relationship____________________Home Phone ( )_________________________ Cell Phone ( )______________________ Work Phone ( )______________

Are you a new participant? ___Yes ___No If yes, how did you hear about NISRA?_________________________________We’ll contact you soon! Best time to call: ___ 9:00 am-12:00 noon ___12:00 noon-3:00 pm ___3:00-6:00 pm

NISRA REGISTRATION FORM–June Virtual Programs

(please specify location)Registering from brochure: ___from child’s school/___adult’s group home ___mailed to me picked up at:____________________

Please give us valuable information to help us provide the safest & best care possible!

Just ONCE A YEAR, we’re requesting that you complete the Annual Information Form (next pages). It’s time

again!

Registration deadline: May 25. Virtual Programs begin June 1

(Name and Relationship)

Contact Information (Family/Guardian/Group Home)

Date rec’d.____By____In computerWait List

Other agency pay ScholarshipNISRA Respite

Check #________Cash_________Charge________

Total Due __________ +/-Credit/Balance Due __________Grand Total= __________Amount Paid __________R / NR

For Office Use Only

Program #

Total Fee Due (submit along with Registration Form)

*Please mail or drop off your form. Email is not encrypted & may get trapped in a SPAM filter. Fax can be difficult to read.Mail or drop off form to: NISRA, 285 Memorial Drive, Crystal Lake, IL 60014

Participant/Parent Signature____________________________________________Date________________

Subtotal of Fee Dueminus any available credits

=-

Please write “none” if you are NOT taking the transportation that is offered.

Program FeeTransportation Location (if offered)* Program Name

NISRA’s Values: Fun • Professional • Trustworthy • Innovative • CompassionatePlease give us your feedback! Use this space for suggestions and new program ideas: _____________________________________________________________________________________________________________________________

Participant Name___________________________________________

Contribution to NISRA Foundation for scholarships, accessible buses, and innovative programs

Please make sure Program # matches the Program Name!

WAIVER RELEASE OF ALL CLAIMS AND HOLD HARMLESS AGREEMENT FOR NORTHERN ILLINOIS SPECIAL RECREATION ASSOCIATION. READ CAREFULLY. Please read this form carefully and be aware that in signing up and participating in NISRA programs, you will be waiving and releasing all claims for injuries arising out of these programs that you or the other named participant might sustain. The terms “I”, “me”, and “my” also refer to parents or guardians as well as participants in the programs. In registering for these programs, you are agreeing as follows: As a participant in these programs, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, damages or loss which I may sustain as a result of participation in any manner, in any and all activities connected with or associated with such activities and involve substantial risks of injury. I agree to waive and relinquish any and all claims I may have as a result of participating in these programs against NISRA, any and all other participating or cooperating governmental units, any and all independent contractors, officers, agents, servants, and employees of the governmental bodies and independent contractors, and any and all other persons and entities of whatever nature that might be directly or indirectly liable for any injuries that I might sustain while participating in these programs. I do hereby fully release and discharge NISRA and the other released parties from any and all claims for injuries, damages or loss which I may have or which may accrue to me on account of my participation in these programs. I further agree to indemnify, hold harmless and defend NISRA and any and all other parties, from any and all claims resulting from injuires, damages and losses sustained by anyone, and arising out of, connected with, or in any way associated with my conduct and the activities of these programs. I further understand and agree that the terms such as “participation”, and “activities”, referred to in this Agreement, include all exercises and physical movements of any nature while I am participating in these programs and further include the provision of or failure to provide proper instructions or supervision, the use and adjustment of any and all machinery, equipment, and apparatus, and anything related to my use of the services, facilities, or premises involved in these programs, and transportation to and from any events. I understand the nature of these programs for which I am registering and have read and fully understand this Waiver, Release and Hold Harmless Agreement. I further understand that any advisements or warnings of the particular risks of these programs that I subsequently receive will be incorporated by reference into and become a part of the Agreement. Photo release. NISRA takes photos & video of participants in programs. By signing the waiver, you are giving permission to NISRA to use these photos & videos in our publications, on our website and social media outlets without further permission and without any compensation to you. All photos & video are the property of NISRA. In case of emergency, I give my permission for the participant to receive any first aid, transportation or medical attention that may be required.A facsimile signature shall substitute for and have the same legal effect as an original form signature.*

Payment type: check cash Mastercard VISA Discover other (ex. respite or other agency pays) Account # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration Date ___/___ Security Code (back of card)_____Cardholder Name (please print) ____________________________________ Signature_____________________________Cardholder Address_________________________________________ City______________________ State____ Zip_________