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The Participant Assessment and/or proof of vaccination is no longer required as of February 28, 2022.

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

NSSRA 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.   

We have established eligibility and safety guidelines for staff and participants.  Participants interested in registering for in-person programming who do not voluntarily provide proof of Covid-19 vaccination 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 at least one week prior to the registration deadline.


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 determined by state and local COVID-19 guidelines, staff availability, facility space and transportation parameters and overall safety of the program offering.
  • NSSRA programs offered will be structured to allow participants and staff to keep social distance from others.  Participants, including fully vaccinated individuals, must wear a mask when in the presence of individuals age 4 and under, indoors and outdoors.
  • Participants and staff, including fully vaccinated individuals, must wear a mask when on NSSRA vehicles.
  • NSSRA will provide the proper staffing to meet the needs of our participants, per guidelines, assessment outcomes, and eligibility requirements, however there is no guarantee that participants or staff will be vaccinated.  NSSRA staff will wear a mask while in programs. 
  • NSSRA will ask COVID-19 screening questions at the participant’s arrival or transportation pickup to continue to minimize risk.
  • 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.
  • Participants will be responsible for bringing their own mask each day.
  • Staff will teach and reinforce the use of mask with verbal and visual supports to all participants and staff.
  • Staff will have cue cards accessible to share as reminders for participants to properly wear a mask.
  • NSSRA will provide a break space for removing of masks for one individual at a time when possible.
  • Wash hands and disinfect area before and after each use.
  • Minimize time talking with program staff or participant for continual flow of drop-offs/pick-ups, maintain physical distance with other participants/families, wear a mask when dropping off/picking up a participant.
  • 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 the program after it has been 5 days from the time of the exposure, unless they are fully vaccinated.
  • 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 individual with a positive test result) AND at least 5 days have passed since symptoms first appeared (if symptomatic) or a 5-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 participants 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?