Abilities Centre Re-Imagined Fall Program Open House

Thank you for your interest in Abilities Centre fall programming. Through August 30 to September 15, we are offering a series of free activities for community members to come in to the facility and give some of our new program offerings a try before registering for a full program. The activity days are open to any community member with the option of registering for a full program starting the week of September 20, 2021. All on-site visitors will be expected to adhere to Abiltiies Centre's health and safety protocols and to complete a COVID-19 attestation prior to arrival on your select program day. A confirmation email will be sent to you from Abilities Centre's programming staff after you complete the form below with instructions for your visit to our facility.

Participant Information

Please fill out the boxes below for the person who will be participating in the activity. Please note that a separate form must be completed for each family member attending in order to adhere to COVID-19 Health & Safety protocols and building capacity limits. There will be a maximum of 15 participants per program available.

Please describe.

Emergency Contact

Program Registration

Please select the dates and times for the programs that you would like to attend.

Programming will include a trial of 3 fall programs including: Obstacle Course, Kinball, Pickleball, Floor Curl and more!

Programming will include a trial of 3 fall programs including: Obstacle Course, Kinball, Pickleball, Floor Curl and more!

Liability & Waivers

Abilities Centre is committed to protecting the privacy of its members. Abilities Centre staff treat the personal information of individuals participating in the Abilities Centre programs as confidential and share such information only as required by law or for consistent purposes as outlined in the Freedom of Information and Protection of Privacy Act. Individuals have a right to know how their information has been used and to whom their information has been disclosed. Personal information about individuals participating in the Abilities Centre programs are used for the sole purpose of facilitating the programs. It is treated as confidential, securely stored, and is accessible to and shared amongst Abilities Centre staff only on a need to know basis. By clicking the box, and in consideration of my (or my son/daughter's) participation in Abilities Centre programs, I consent and authorize Abilities Centre to collect data through surveys and questionnaires with de-identified identification number provided by Abilities Centre (to ensure confidentiality). All information is collected for the purpose of Abilities Centre evaluation. All information that is collected is kept private and confidential, entered into a computer database and stored in a locked office on a password protected laptop accessible only by Abilities Centre program staff and research team. No identifying information, such as your (or their) name, will appear in the database. All the data will be aggregated to further protect the confidentiality of your (or their) responses.

By clicking the box, and in consideration of my (or my child’s) participation in any Abilities Centre program, I hereby release, waive and forever discharge Abilities Centre and their respective agents, officials, officers and employees of and from any and all claims, demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property howsoever caused, arising or to arise directly or indirectly by reason of my participation in the activity, whether as a participant, spectator or otherwise, whether prior to, during or subsequent to the activity, and notwithstanding that same may have been contributed to or occasioned by the negligence of any of the aforesaid. I further hereby undertake to hold and save harmless and agree to indemnify Abilities Centre all the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with, my participation in the activity.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization and COVID-19 is extremely contagious. In response to the pandemic, Abilities Centre has put in place preventative measures to reduce the spread of COVID-19 in order to assist in supporting the health and safety of all members, program participants and staff. While measures have been put in place, we cannot guarantee that individuals accessing our programs or facility will not become infected with COVID-19. Further, attending the facility and participating in programs could increase your risk of contracting COVID-19. By clicking the box below, I confirm that: • I am the parent/guardian of the participant being registered and have full legal responsibility for the decisions of said participant. • It is both the responsibility of the participant and myself, as the parent/guardian, to ensure that we are following the recommended guidelines outlined by Abilities Centre and program staff to limit exposure of COVID-19. • I understand that I have the responsibility of reporting any symptoms of COVID-19 to the respective health authorities and refraining from attending any programming until 14 days has passed since the occurrence of symptoms. • I understand that the participant may be exposed to or infected by COVID-19 and such exposure may result in personal injury, illness, permanent disability or death and I agree to assume the risks for participation in Abilities Centre programming and agree to release, waive and forever discharge Abilities Centre from any claims, action or charge related to the participant contracting any symptoms or illness related to COVID-19 during programming. • I agree that the participant will not attend at the Abilities Centre if they are exhibiting any COVID-19 symptoms and/or if they have been advised to self-isolate.

I consent to receive offers and other promotional and marketing materials by email from Abilities Centre. I understand that I can later withdraw consent by using the unsubscribe option in emails or contacting the sender.

By inputting my initials below, I confirm that I have read all information above (including clicking links to documents) for each box I have checked.