Survival Swim Rays Lessons Registration

Survival Swim Rays Registration Form

Please fill out the form below and pay the registration fee in order to secure your time slot!
Classes are 3 days per week, Monday through Wednesday, and are up to 13 minutes per day. Scheduling is done through Coach Hannah. You will keep your scheduled time for the remainder of the lessons.

The registration fee & form must be paid and filled out before time slot is secured. The registration fee is non-refundable and only valid for the season you are currently registering for.

Failure to recieve payment may result in your time being forfeited.

If for any reason you choose to forfeit lessons during your alotted 6 weeks- the current weeks tuition is still due.

DO NOT FILL OUT THIS FORM UNTIL YOU HAVE SCHEDULED WITH HANNAH

Contact info:

904-505-7491 (call/text)

survivalswimrays@gmail.com
Parent/Guardian and Emergency Contact Information
Did you schedule lessons with Hannah already and have a start date? If not, please contact her before registering.
Parent #1 Name

First NameLast Name
Relationship to Student
Parent #1 Email Address
Parent #1 Phone Number
Parent #2 Name

First NameLast Name
Relationship to Student
Parent #2 Email Address
Parent #2 Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Swimmer Information
What is the start date and time slot you are registering for?
(MM/DD/YY, 00:00pm)
Student #1 Name

First NameLast Name
Student #1 Birthday

MonthDayYear
Date
Describe all in water experience (ex. nearly drowned, had traumatic water experience, has been in water but cannot swim, has had swim lessons of some sorts before)
Has Student #1 ever seen a medical specialist or had any non-routine health or behavioral issues? Please explain, if yes.
Student #2 Name

First NameLast Name
Student #2 Birthday

MonthDayYear
Date
Describe all in water experience (ex. nearly drowned, had traumatic water experience, has been in water but cannot swim, has had swim lessons of some sorts before)
Has Student #2 ever seen a medical specialist or had any non-routine health or behavioral issues? Please explain, if yes.
Please click yes if you WILL give permission to have photographs of your child taken
Release of Liability: I release and hold harmless Survival Swim Rays, its owners, operators and instructors from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participants and/or the undersigned, while in or upon the premises under the control and supervision of Survival Swim Rays, its owners, operators, pool hosts, or in route to or from any of the said premises. I also acknowledge that enrollment, participation in or completion of lessons in no way implies that the participants are drown proof or water safe and that as the parent or legal guardian of the participants, I am ultimately responsible for my child’s safety in or around the water and must at all times ensure appropriate, vigilant and persistent supervision.
Assumption of Risk: I understand, agree and acknowledge that there are risks inherent in sports activities conducted by Survival Swim Rays and its instructors. These activities may be of hazardous nature and/or may include swimming, diving and a variety of strenuous exercise and physical activities. With the full understanding of the facts, I state that to the best of my knowledge, the participants I am registering have no medical, physical, or emotional conditions that would hinder or prevent safe participation in Survival Swim Rays.
Enrollment Review and Payment Policies: I understand that I am enrolling for swim lessons with Survival Swim Rays and that the information submitted on this enrollment form will require review as it is the intent of Survival Swim Rays to provide each participant with an individualized, effective and safe learning experience. I acknowledge that in some health-related cases, Survival Swim Rays may not be able to provide services. I certify that all medical/health information I have provided is correct and true and agree to provide additional information, including a physician’s clearance if requested, prior to the beginning of any lessons. I understand that in order to secure my child’s selected lesson time I must pay all applicable registration fees per the instructions sent to me. I understand that participant enrollment may be cancelled if payment is not received. I understand that weekly tuition is to be paid in a timely manner and failure to do so could result in losing my allotted time. I understand should I receive lesson credits that they are only valid for one year to the current date.
New student registration:

$115 first year student

$200 for 2 children

$75 each additional child

Returning students:

$60 to reserve time slot

(does not go towards weekly tuition costs)

Weekly tuition fee: $115 per child

Weekly tuition is to be paid every Friday before the following weeks lesson.

Failure to pay in a timely manner will result in a $15 late fee.

Lessons will be postponed until account is brought up to date.
Signing your name below constitutes that you are in full agreement to the terms outlines above and submits your electronic signature.
Please type your name
Full Name
Registration payments can be sent to:

Zelle: 9045057491

Venmo: @hryxray

ApplePay: 9045057491
Thank you!

I look forward to meeting you and your little swimmer(s)! Thank you for the opportunity to teach your child(ren) this lifelong skill!
Keep up with us on social media!

Facebook: www.facebook.com/survivalswimrays Instagram: instagram.com/survivalswimrays
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Survival Swim Rays Registration Form

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