Participant Information

Persons interested in participating in the Walk On program, please be aware of the following process. Call Walk On at 847-381-4231, state your interest. Be prepared to provide:

1. Your name, address, and telephone number
2. Pertinent information regarding the potential rider, including diagnosis, special needs, available days and times.
3. Secure a referral from your physician for an Occupational Therapy evaluation to be brought at the time of the initial evaluation.
4. Your name will be placed on the Waiting List.
5. You will be notified when a vacancy becomes available which matches your availability.
6. You will need to complete the following forms from the web site:
1. Registration
2. Authorization for Emergency Medical Treatment Form
3. Health History
4. Release Form
5. Participant Liability Release
6. Non-Disclosure and Confidentiality Agreement
7. Participant’s Medical History & Physician’s Statement
8. Letter to Physician
9. Physician’s Referral
7. Copy the Participant/Parent Handbook
1. Review and become familiar with the rules and guidelines
2. Be sure to check and sign the Participant Handbook Checklist on page 4 of the Registration packet
3. You will be contacted to have an initial assessment to determine your
eligibility for the program, be sure to bring the Physician’s Referral to this assessment.

Participant Forms

	Participant Registration Form
	Authorization for Emergency Medical Treatment Form
	Participant Health History
	Participant Release Form
	Participant Liability Release
	Participant Confidentiality
	Participant Medical History & Physician's Statement
	Participant Letter to Physician
	Participant Physician Referral
	Participant Handbook