Information and Consent Form 1 of 2 Wavier Forms

Your Name

First NameLast Name

Child’s Name*

First NameLast Name

Child’s age *

Phone Number*

Area CodePhone Number

Email

example@example.com

Lesson Days*

Your Instructor *

I’d like to add a Haley’s Little Fish T-shirt for my child for $20.00, if so please leave your child’s size *

How did you hear about us?*

Has your child attended any type of swim lesson before?*

YesNo

If yes, what type of lessons?*

I understand that Haley’s Little Fish allows ONE absence with eligibility for a makeup lesson as long as a minimum of a THEEE hour notice is given (this does not include weekend lessons or makeups)*

At Haley’s Little Fish, the health and safety of your child is our first priority. Our ability to keep our pool open is dependent on parental responsibility and adherence to policies to ensure that our pool remains clean. A $575 pool contamination fee will be charged in the event of POOL CLOSURE*

I understand that my child should not eat or drink anything other than WATER 3 hours before lessons *

I understand that I WILL NOT allow my child to eat fruit, vegetables, meat or dairy products AT ALL before lessons. This includes milk, yogurt, fruit, meat and cheese.*

I understand that if my child causes a pool contamination of any sort, I will be charged a $150 up and chemical fee by pool company*

If my child is THREE years old and younger, I understand that I have to DOUBLE swim diaper, my child. (Two REUSABLE swim diapers) If an accident occurs in the pool, I understand that I will be charged $575 for cleanup fees. If I do not have an appropriate diaper on my child, I understand that I am forfeiting that days lesson. *

We have provided links on our website

I recognize and acknowledge that I am enrolling my child in survival swim lessons and will not hold Haley’s Little Fish or the instructor teaching my child liable for any accident that may occur in or around the pool area. *

I understand that I am only eligible for one make up lesson per session *

I understand that there are NO refunds given and no lesson credit transfers. All makeup lessons must be used within 14 days*

I understand that I do not get a makeup lesson for a makeup class that I have booked. I understand that I do not get makeup classes on weekend lessons booked.

I understand that if I am more than five minutes late for my lesson, I am for forfeiting that lesson. *

Haley’s Little Fish suggests that all students enrolled in lessons should be covered by their own family insurance policies. If injury should occur it is understood that the student’s own policy is your only source for reimbursement. *

I understand that no child is “drown-proof” and should watch my child at all times around any body of water *

What do you want your child to gain from these lessons?*

I understand that it is my responsibility to notify my instructor of any and all medical history changes or health concerns*

Does your child have any medical history we should know about? *

Is there any additional information we should know about your child?*

Thank you for filling this form out. We are excited to meet you and your little one! Make sure to follow us on Facebook and Instagram for updates and news.

Signature*