Rec & Roll Adult Day Program Interest Form

New participants are welcome to join WDSRA’s adult day program, Rec & Roll at any point throughout the year. WDSRA offers several locations within our day program to meet the needs of our communities and families. Each location, and ratio, has specific participation requirements that must be met to be considered for the program. The Day Program Assistant Managers will assess and determine which program best meets the needs of each individual interested in the day program. New participants may be placed on a waitlist until a spot becomes available and are subject to a assessment period upon entry. Please complete the form below to help our staff learn more about your participant and the day program you are interested in. Our Day Program Assistant Managers will get back to you within 1 week of your inquiry. NOTE: Residents will receive priority on waitlist before non-residents.

Contact Information

Interested Participant's Name(Required)

First Last

Disability(s)(Required)

Primary Guardian's Name

Guardian's Relationship to the Participant

Address(Required)

Street Address Address Line 2 City ZIP Code

Preferred Method of Contact

Your Email Address(Required)

Your Phone(Required)

How Did You Hear About Rec & Roll?

Thank you for your interest! A Day Program Assistant Maanger will contact you within 7 business days of the form being submitted.

NOTE: Regardless of your preferred start date, you may receive a phone call earlier about an open spot. Declining a spot could move you to the bottom of the waitlist.

Rec & Roll Interest Form