Registration Form09 Private

DS Recreational Services, Inc. Learn-to-Swim Program 2009 Registration Form 2510 Farrell Road – Houston, TX 77073 – (281) 443.7665 – (281) 443.1524 fax All forms must be returned to the DS Office with payment before the lesson date. Participant Information: Participant Name: _____________________________ Birth Date: __________________ Circle one: Male Female Street Address:__________________________________________________________________ City: ______________________________ State: ________ Zip: ________________ Telephone: ______________________________ Mobile:__________________________________________ Email Address: __________________________ Parents Name(s): __________________________________ Policies: 1. 2. 3. 4.

DS reserves the right to cancel programs if minimum number of participants is not met. Registration is accepted on a space available basis. Refunds will not be given for programs cancelled by participant. Program staffing is based on the number enrolled. Make-up lessons are ONLY given for classes cancelled due to inclement weather.

How to Register: 1. 2. 3.

Complete the appropriate sections on the registration form. Each individual participant must fill out a registration form and pay for the lesson prior to start of classes. Additional registration forms can be picked up at DS Recreational Services or you may download them from our website at www.dsrec.com. Return Registration Forms to DS Recreational Services in person, by mail or fax your form to 281.443.1524. If you are faxing, please call to confirm your fax was received.

Lesson Type (Circle One):

Private

Semi Private

Pool Choice: _________________

Please Read & Sign Payment: We must receive your payment in full before any swim lessons are scheduled. Refunds: You may cancel your lessons up to but not less then fourteen (14) days before your first lesson begins. You will receive your payment for lessons ONLY. DS will retain ALL registration fees. Makeups: We will give makeup lessons for Private & Semi Private lessons for any reason if we are notified 24 hours before your class time. Makeup lessons for Group Sessions are only given for severe weather. The instructors are being paid whether or not you are there. Please call the office if you cannot make a lesson. It is not our instructor’s responsibility to inform the office if you cannot make a lesson. Office phone is 281.443.7665. Stormy Weather: If your class is cancelled due to weather, we will give you a makeup class. If the weather looks questionable prior to your class, please call the office to see if we are still teaching. The instructors will notify the office if they are out of the water. If the weather is severe enough to send the instructor home, we will notify you. Location Use: Only the scheduled student may swim during their class time, unless you have a membership to that pool and the pool is open for recreational swim. In order to create an environment more conducive to your child’s learning experience, parents and siblings must stay outside the pool gate during swim lessons. Parent/Child Classes: Your child must wear a swim diaper if he or she is not completely “potty trained”. You may purchase reusable diapers or disposable water diapers. Your child will not be able to get in the water with a regular diaper; you will not receive a refund for that class if your child cannot participate due to lack of a swim diaper. I/We, understand that DS Recreational Services, Inc., its staff members and the contracted organization where programs are held cannot be held liable for injuries while at the program location or otherwise under the supervision of its staff members. Knowing that DS Recreational Services, Inc. will do its best for the safety of its clients, I/We assume all responsibilities and waive any claims that may arise from any injury while participating in the swimming lessons. Signature of Student or Parent (If Student is Under 18 years of Age) ___________________________________ Date ____________

Payment Method Name: (Print) _____________________________________________________________________________________ Cash $ _________ Check # _________ Credit Card # ___________________________________________ Type of Card: _____________ Expiration Date: ________ Number of Lessons Purchased:_______________ Rate per Lesson: $_____________+ $12.00 Reg. Fee TOTAL:__________