Skip to form


Participant Assessment
(This form only needs to be completed once. If you are currently participating in-person, do not complete this form again.)

NSSRA Return to In-Person Programming

NSSRA will be evaluating in-person program opportunities on a month-to-month basis and will provide seasonal program information and registration periods.  In-person programming will supplement the current virtual programs, which will continue throughout the year. 

We have established eligibility and safety guidelines for staff and participants.  Participants interested in registering for in-person programming will be required to complete an assessment to determine eligibility.  Once the assessment is submitted, staff will review the assessment, pair it with recent experience with the participant (if any), and call families to ask any additional questions staff may have and ultimately to let them know the outcome.  As always, evaluations of reasonable accommodations are made on a case-by-case basis to ensure that NSSRA has as much information as possible about the specifics of the request being made, and NSSRA retains the right at all times to re-evaluate participation when a situation is creating a direct threat of safety.

To determine eligibility for programs, a Participant Assessment must be submitted based on the following timeline:

Session Participant Assessements Due Registration Period Programs Run


February 8, 2021 February 15-26 March 22-April 24 & April 26-May 22
Summer Session I April 26, 2021 May 3-14

June 14-July 10

Summer Session II May 24, 2021 June 1-11 July 12-August 7
Summer Session III June 21, 2021 June 28-July 9 August 9-29

Participant Eligibility

  • Ability to maintain a 6 foot physical distance from other participants and staff
  • Ability to properly put on, wear, and take off a face covering when necessary, for the duration of the program
  • Independent personal care (i.e. hygiene, toileting, feeding)
  • Participate with visual and verbal prompting within a ratio of one staff to four participants
  • Ability to follow the NSSRA Code of Conduct and other pre-determined guidelines


Although recreation programs always have an inherent risk, NSSRA has taken several measures to promote safety and wellness in our programs.

  • Program capacity will be a maximum of up to 15 individuals inclusive of staff and participants, pending facility capacity and Illinois Department of Public Health recommendations.
  • Participants and staff must perform an at home self-health check every day prior to arrival at program. Instructions for the self-health check will be provided prior to the start of programs.
  • Face coverings must be worn by participants and staff at all times.  The only exception to this is when the program is outside and staff and participants can maintain physical distancing of at least 6 feet or when exercising. 
  • Participants must provide their own face covering. Face coverings should:
    • Have 2 or more layers of breathable fabric.
    • Completely cover your nose and mouth and can secure under your chin.
    • Fit snugly against the side of your face and do not have gaps.
  • Staff will develop a pick up and drop off system for each program to ensure proper physical distancing.  Parents and caregivers must wear face coverings and stay in their vehicle when dropping off and picking up participants.
  • Participants must adhere to a strict hand washing schedule.
  • Staff will clean and disinfect frequently touched surfaces (table tops, door handles, etc.) before and after activities and in between uses of different individuals.
  • Participants will be provided a supply kit to limit the need for sharing.
  • Toys and learning tools not able to be sanitized will not be used.
  • NSSRA will take measures to promote 6 foot physical distancing like seat assignments, outdoor activities, barriers, and traffic flow patterns. 
  • Participants and staff displaying symptoms of illness during the program will be removed from the group, and an approved adult will be required to pick them up within 30 minutes of notification. Participants will be supervised by staff while removed from the group. Participants will be required to have multiple emergency contacts to ensure that someone is available to pick them up if the need arises.
  • Participants who have been exposed in close contact to someone with confirmed COVID-19 may only return to program after it has been 14 days from the time of the exposure.
  • Participants diagnosed with or exhibiting symptoms of COVID-19 can return to programs after:
    • Submittal of release from isolation documentation from a healthcare provider or local health department
    • OR
    • The individual has had no fever for at least 24 hours (one full day without the use of medicine that reduces fevers) AND
    • Symptoms have improved or the participant never had symptoms (such as in the case of an asymptomatic employee with a positive test result) AND
    • At least 10 days have passed since symptoms first appeared (if symptomatic) or a 10- day period has passed since the positive test was taken (if asymptomatic)
  • If participants have illnesses like allergies, or other non-contagious conditions that may appear similar to a contagious illness, a note from a physician stating they are not contagious is required prior to attending program.
  • To protect your participant and those they interact with, participants that do not adhere to program rules and the above guidelines may be removed from the program.

Participant's Full Name

Who is completing the assessment?


What level of support does the participant need to do the following:


With limited verbal prompts is the participant able to do the following:

Properly put on, wear, and take off a face covering when necessary, up to the duration of the program?

Keep a face covering on for long periods of time?

Maintain physical distance of 6 feet or more from others?

Independently wash hands?

Cover a cough or sneeze?