Social Night Registration

**COVID PROTOCOL**

All Staff, Clients and Visitors must show proof of vaccination.

We are following all COVID protocols as outlined by Public Health.

Programs are open to participants who can be in our programs in safe and independent ways,

or who can bring a Support Worker for personal care and engagement.

Thank you for understanding.

 

Social Night runs from 5:30pm to 8:00pm 

 

2021/2022 Dates:

October 13th, 2021
October 27th, 2021
November 10th, 2021
November 24th, 2021
December 1st, 2021

December 15th, 2021
January 5th, 2022

January 19th, 2022
February 2nd, 2022
February 16th, 2022
March 2nd, 2022
March 23rd, 2022
April 6th, 2022
April 20th, 2022
May 11th, 2022

May 25th, 2022

June 8th, 2022
June 22nd, 2022

 

After completing and submitting this registration form please wait for confirmation from the Recreational Coordinator  before choosing and paying for your young adult's Social Night dates.

 

Immediately after completing this form please email a photo of your young adult to recreation@redroofretreat.com

***YOUR REGISTRATION WILL NOT BE PROCESSED WITHOUT A PHOTO OF YOUR YOUNG ADULT***

 

***Payment MUST be made by the Thursday at 4pm before the session you wish to register your teen for. If this deadline is not met, you will not be able to register your young adult for that program date.

 

We are unable to issue refunds without adequate notice. Cancellations must be made by 4pm on the Monday before your young adult's scheduled program date.

Program Registering For (Please Check Off):

Contact Information

Country*
Email*
Confirm Email*
Phone*
Mom's Cell Phone Number
Moms Work Phone Number
Dads Cell Phone Number
Dads Work Phone Number

Registration Form

Teen's Name*
Date of Birth (DD/MM/YYYY)*
Enter Teen's Age*
Health Card Number & Letter*
Doctors Name*
Doctors Phone Number*

Emergency Name & Contact Number (other than parents):

Emergency Contact Name (1)*
Emergency Contact Number (1)*
Emergency Contact Name (2)*
Emergency Contact Number (2)*
Person Responsible for dropping off*
Person responsible for picking up*

Health Information

Diagnosis*
Please list Medications, Dosage/Time, Route:*
Behavioural Concerns*
Allergies*

Waivers

By submitting this registration form you agree to:

 

I/we the parent(s)/guardian(s) are aware of this application and are in agreement with the above application requirements (ie. payment of fees and waivers to be signed). I/we are aware of the nature of Red Roof Retreat’s programs and give consent for my/our young adult to participate.

 

Photo/Video Release

I, consent to the use of any photos or videos taken of my young adult during Social Night.

 

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 Social Night program.

 

Release and Indemnification

In consideration of Red Roof Retreat accepting within the application, I, parent/guardian of registered young adult agree to indemnify and hold harmless Red Roof Retreat, its servants, agents or employees and all other organizers, sponsors, representatives and any other person or organization assisting in this Social Night 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 or my property incurred while attending at or participating in the Social Night, notwithstanding any such loss, injury or damage that may have risen by reason of the negligence of Red Roof Retreat, its servants, agents or employees and all other organizers, sponsors, representatives and any other person or organization assisting in this Social Night program, arising out of or in consequence of the attendance or participation by our young adult at Social Night operated by Red Roof Retreat.

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