Liability Waiver
Jasmine's Swim School
Parent/Guardian's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Swimmer 1 Name
*
First Name
Last Name
Swimmer 1 Age
*
Swimmer 2 Name
First Name
Last Name
Swimmer 2 Age
Swimmer 3 Name
First Name
Last Name
Swimmer 3 Age
Swimmer 4 Name
First Name
Last Name
Swimmer 4 Age
Swimmer 5 Name
First Name
Last Name
Swimmer 5 Age
I understand and acknowledge that swimming is a dangerous activity that ay result in injury or death.
*
Yes
I assume all risk associated with swimming and related activities to swimming lessons taken at 9508 S. Kirkside Dr. South Jordan, UT, residence of Shellie and Joseph Peterson.
*
Yes
If participant and/or guardian of participant (including those observing swimming lesson) sick or in any way feeling unwell, we ask that you NOT attend your regularly scheduled lesson time. Please work with the instructor to reschedule lessons for another time.
*
Yes
Please respect social distancing protocols. I assume the risk associated with illnesses that may occur.
*
Yes
I indemnify and hold harmless the property owners, Shellie and Joseph Peterson, from any actions, damages, or other loss due to accident, injury, or death associated with swimming activities.
*
Yes
Signature
Submit
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