partnership with Get your FEAT Wet!

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1 In FEAT of Louisville partnership with Get your FEAT Wet! In partnership with FEAT of Louisville, The Home of the Innocents 92 Degree Therapy Pool is offering private swim lessons to children with autism, beginning in January The salt water pool is an ideal, relaxing and therapeutic environment for children to grow comfortable in the water, with its extra-warm water and air temperature, multi-colored lights, echo-reducing tiles and underwater speakers. Our teaching method is gentle, user-centered, fun and progressive, starting with water confidence exercises, and if appropriate, moving toward swimming with face down in the water. Eight (8) 30 minute lessons are $180. Lessons are held once a week, and progress reports are provided. Partial scholarships may be available through FEAT of Louisville based on need. Contact Home of the Innocents to schedule lessons, and lesson hours are gradually being expanded. Because the lessons are held in a 92 degree therapy pool, a therapy pool permission form (signed by an MD, physician s assistant or nurse practitioner) and release are required for each child. You may download the required forms and map to the pool from the Home of the Innocents website under Programs, and Aquatic Therapy submenus. DAYS: Thursdays, starting Jan 10 TIMES: 3-3:30; 3:30-4; 4-4:30; 4:30-5 pm FOR REGISTRATION FORMS: call us! for registration forms Home of the Innocents Kay and Jim Morrissey Advanced Therapy Center 1100 E. Market Street (at the corner of East Main), Louisville, KY (502)

2 GET YOUR FEAT WET Registration Form and Agreement All forms must be received by Home of the Innocents pool staff before scheduling lessons Age group: Other Child s Name D.O. B Phone Address Have you/your dependent ever had swim lessons? If so, when and where? Please list any medical, emotional or behavioral conditions that we need to be aware of for the children participating in swim lessons in our 92 degree therapy pool. I understand that the Home of the Innocents has partnered with FEAT to offer swim lessons and that: Private, 1 to 1 swim lessons will be offered to me, my child(ren) or the child(ren) I am guardian of. The cost of this 8 week session of private 30 minute lessons is $180 per child. I understand that that no refunds are available once the lessons begin due to not being able to fill the slot on short notice. One excused cancellation will be permitted, but the lesson must be made up within the eight week session at a time convenient to both instructor and parents. When cancelling I must give 24 hours notice, and unexcused absences will be counted as part of the 8 lessons. Due to the water temperature, the attached medical permission form, pool rule agreement/ liability release and this completed registration form are required to be provided for each child before scheduling swim lessons. I agree to abide by all attached rules and health conditions required for use of the pool. The Home of the Innocents method is gentle, fun and progressive, starting with water confidence exercises, building toward swimming with face down in the water. for all lessons, a parent, guardian or other designated adult will remain on the pool deck to oversee the swim lesson. I understand that this regulation is required for the protection of both the student and the instructor. appropriate physical contact will be necessary to encourage proper swim skills and techniques. swim lessons are progressive, and I agree to attend all eight lessons as scheduled. Parent or guardian signature Date

3 THERAPY POOL CONSENT FORM ADVANCED THERAPY CENTER 1100 EAST MARKET STREET PHONE FAX To be signed by a Physician, Nurse Practitioner or Physician s Assistant Date: Patient Date of Birth Patient s Phone: Parent s Name (if applicable): Patient Name: Gender: M F Race/Ethnicity: Address: City: State: Zip Code: PHYSICIANS: PLEASE FILL IN THE FOLLOWING BELOW AND SIGN: I APPROVE THE USE OF THE ADVANCED THERAPY CENTER AQUATIC POOL FOR (Patient Name) FOR THERAPEUTIC USE. IN MY OPINION, IT WOULD BE IN HIS/HER BEST INTEREST TO UTILIZE THIS HEATED POOL (89-92 DEGREES), LIMITING EACH VISIT TO 1 (ONE) HOUR PER VISIT. THIS PERMISSION IS VALID FOR A PERIOD OF 12 MONTHS. MD/NP/PA NAME (Please print) MD/NP/PA SIGNATURE MD/NP/PA ADDRESS MD/NP/PA PHONE This form must be signed by a Physician, Nurse Practitioner or Physician s Assistant, and will be kept on file for one year in the office at The Advanced Therapy Center of The Home of Innocents. It may be delivered in person or by fax machine.

4 Pool Rule Agreement and Liability Release Form Participant Name: (Please Print) Group (if applicable): I have read and agree to abide by the attached Home of the Innocents pool rules. I also understand that participation in the above event or activity could include actions or tasks which might be hazardous to the participant named above. By signing below, I assume any risk of harm or injury which might occur to the participant due to their participation in the event or activity. I release The Home of the Innocents, Inc. from all liability, costs and damages which might arise from participation in the above named event or activity. If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for The Home of the Innocents, Inc. to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment. Signature of Participant: Date: Phone Number: If Participant is a Minor: Name of Parent or Guardian: Signature of Parent or Guardian: (Please Print) Date: Phone Number:

5 Pool Rules read carefully! No food, gum, or tobacco allowed in the pool area. Only water or sport drinks are allowed. No glass is permitted within the pool area. No bandages of any kind, adhesive tape, bunion pads, or corn plasters in the pool. No one may enter the pool that has had diarrhea or vomiting in the last 48 hours. Admission shall be refused to all persons having any contagious disease, or to those with conditions that appear contagious. Persons with excessive sunburn or abrasions that have not healed shall not be admitted. There is an additional charge for other family members who enter the pool. A doctor s consent form is required for use of the pool. Attendants or therapists are not required to have a doctor s consent form, unless they themselves are medically fragile. There is a one hour time limit per visit due to the 92-degree water temperature. No tobacco or alcohol is permitted on the facility property at any time. A person under the influence of alcohol or exhibiting erratic behavior shall not be permitted in the facility area. Everyone must complete the sign in sheet at the pool front desk. Everyone must supply his/her own towels and other supplies. Only clean aquatic shoes and bare feet are allowed on pool deck. Street shoes must be removed at the door or shoe covers must be worn over the shoes. All pool participants, including staff, must take a shower poolside before entering the pool. For whomever necessary, reusable container diapers shall be worn to prevent incontinence in the pool. This can be important even for patrons who are potty trained, as the warm water relaxes the muscles. We recommend the reusable brands at www. MyPoolPal.com and If there is contamination, the pool must be closed immediately, sometimes the rest of the day, depending on the severity. Non-swimmers and small children must be supervised at all times. When there is no lifeguard or pool attendant on duty, the pool will be closed and locked. Be aware of medically-fragile pool patrons. Follow all instructions of the lifeguard with no exception. The lifeguard has the right to refuse any client use of the pool due to not following the rules. No running or rough play is allowed. No climbing or standing on any of the railings. No diving or jumping into any area of the pool. All pool participants must enter the water via the ramp, steps, or ladder. Respect and care for facility equipment. No hanging from basketball rim and volleyball net. All apparel worn into the facility shall be clean and proper. A doctor s consent form is required for anyone medically fragile, pregnant, with heart condition, high blood pressure, or diabetes. Please inform the staff of any special medical considerations.