Swim Registration Form

Swim Success Registration Form Child's Name_____________________________________ DOB____________ Class Level _________ Child's Name______________________________________DOB____________ Class Level _________ Child's Name______________________________________DOB____________ Class Level _________ Parent and/or Legal Guardian Name:__________________________________Phone:___________________ Cell phone________________ Address_______________________________________City_____________________________ State_________________Zip_______________ Emergency Contact (Other than yourself) Name/number _____________________________ Agreement to Follow Rules and Regulations: (Please initial each section) ____ I agree to bring no food or drinks (with the exception of water) into the pool area ____ I understand that cancellation for group lessons must be made at least 10 days in advance in order to receive refund (minus $10 per student administration fee). I also understand that I fail to do so I will not be refunded for the missed class. ____I understand that my child will not be able to make up any missed classes due to illness, conflicts, etc. Make up classes will only be offered for classes canceled due to thunder/lightening. ____I understand that if I decide not to bring my child due to weather and the class is not canceled, my child will not be able to make up this class. ____If I choose to stay and watch my child's lesson, I agree not to interact, disrupt, or disturb the class lesson unless in case of an emergency. ____I agree at all times to abide by all rules established by Swim Success, and will ensure that my child complies with those terms. I understand and acknowledge that if my child or I fail to abide by such rules at any time our child may be removed from the program. _______________________________________________ Signature

__________________________________ Relationship to the child

Release and Waiver of Liability: Here at Swim Success, safety is our #1 priority! We keep our class size and student to teacher ratio small to keep our lessons safe. However, we ask that you read this form careful and be aware that in registering yourself or your child for participation in swimming lessons at Brittany's Swim School, you will be waiving and releasing all claims for injuries you or your child might sustain arising out of participation in the programs or being on the property. I _______________________________ recognize and acknowledge that in enrolling my child in swimming lessons, there are certain risks of physical injury to participants. I agree to assume the full risk of any such injuries, damages, or loss regardless of severity which I or my child may sustain as a result of participating in any of the swim programs. I hereby fully release and discharge Swim Success, and its owners from any and all claims resulting from injuries, damages and losses sustained by me or my child, and arising out, connected with, or in any way associated with activities of any of the programs, or the property on which Swim Success operates. ______________________________________ Signature

___________________________________ Relationship to child