Red Roof Retreat's Dads Swim

Contact Information

Which program are you registering for:
  • Dads Swim
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Dads Information

Allergies*
Health Card Number & Letter*
Doctors Name*
Doctors Phone Number*
Emergency Contact Name*
Emergency Contact Number 1*
Emergency Contact Number 2

Child Information

Childs Name*
Date of Birth*
Age*
Allergies*
Health Card Number*
Doctors Name*
Doctors Phone Number*

If "yes", please continue below.

If "no", please skip the remainder of this section.

Childs Diagnosis
Behavioural Concerns

Acknowledgement and Agreement

By clicking "submit" below, you agree to:

 

I/we the parent(s)/guardian(s) are aware of this application and are in agreement with the above application requirements. I/we are aware of the nature of Red Roof Retreat’s programs and give consent for my/our child to participate in Dad's Swim.

 

Photo/Video Release

I, consent to the use of any photos or videos taken of my child and/or myself during Dads Swim.

 

Oath of Confidentiality

To demonstrate respectfulness to others, I/we agree to keep confidential all information concerning other children/families being served by the Red Roof Retreat/Niagara Ina Grafton Dads Swim.

 

Release and Indemnification

In consideration of Red Roof Retreat/Niagara Ina Grafton Village accepting within the application, I parent/guardian of a Dads Swim child agree to indemnify and hold harmless Red Roof Retreat and the Niagara Ina Grafton Village, its servants, agents or employees and all other organizers, sponsors, representatives and any other person or organization assisting in this Dads Swim program from any claims, demands, damages, actions or causes of actions arising out of or in consequence of any loss, injury or damage to my person, my child or my property incurred while attending at or participating in Dads Swim, notwithstanding any such loss, injury or damage that may have risen by reason of the negligence of Red Roof Retreat and the Niagara Ina Grafton Village, its servants, agents or employees and all other organizers, sponsors, representatives and any other person or organization assisting in this Dads Swim program, arising out of or in consequence of the attendance or participation by at Dads Swim operated by Red Roof Retreat and the Niagara Ina Grafton Village.

 

Liability

Beginning January 2018, the structure for Dad’s Swim will be changing. There will no longer be a Red Roof Retreat staff member on site for the duration of Dad’s Swim and therefore no lifeguard.

Dad’s Swim will be a self-sufficient program. Day Program staff and clients will set up chairs, tables, plates and napkins before the start of Dads Swim and Red Roof Retreat will continue to provide pizza (delivered by Pie Guys), drinks and access to the pool.

                The attending Dad’s will be responsible for the following:

  1. All supervision of their own child(ren) during the duration of the entire Dad’s Swim program night
  2. Direct supervision of their own child(ren) in the pool
  3. Clean up of pizza and garbage (Day Program staff and clients will clean up chairs/tables the following day)

 

By clicking "submit" below, you agree to all of the above terms. You also assume any and all risk associated with swimming and with the entire Dad’s Swim program and will not hold Red Roof Retreat or the Niagara Ina Grafton Gage Village, their staff or volunteers responsible for any incident that should occur. You also assume full responsibility for yourself and your child(ren) during the entire duration of the Dad’s Swim Program.

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