top of page

If you need special accommodations to participate in A Child's Dream-CA activity or event, please contact us by e-mail at, download, complete, and return the above Medical Information Request & Release Form; at least two weeks prior to the event’s date.

Special Needs Requests

This applies to any child who may have a health condition that influences their abilities to adhere to the protocol of A Child’s Dream-CA Outreach.  ACDCA wants each child to have the opportunity to participate in the Outreach and encourage the care-provider to work with us in identifying reasonable accommodations if needed.

 A Child’s Dream-CA accommodation procedures are in support of the Americans with Disabilities Act and the attached medical information is necessary to implement this process.  On receipt of the medical information, we will work together with our Disability Services Representative (DSR) to:


  • Identify whether accommodations are needed,

  • Determine if reasonable accommodations are available

  • Implement applicable accommodation strategies. 


This health information is considered confidential and only information necessary to the implementation of needed reasonable accommodations will be shared with the Outreach.  All information is considered confidential and written documents will be destroyed after the Outreach. You will be required to re-submit documentation for each Outreach you wish to attend.


We encourage you to discuss your health concerns as they relate to your participation in the Outreach with your child's health practitioner.


We also encourage you and/or your child's health practitioner to contact ACDCA at 424-209-2352 with any questions regarding this interactive process. 


Please download the Medical Information Request Form and Release of Information, complete, and have your health practitioner address the questions on the form.  


Upon request, we will provide you a cover letter with the above information or speak with your child's health provider if necessary.


We look forward to hearing from you. 


Please return the completed form to ACDCA via email: no later than at least two weeks prior to the event date.


Cassandra Steptoe-Sampson




bottom of page