Bubbles and Kicks Swim Lessons Registration

Parent(s) Name(s)*

Email Address*

Best Contact Number*

YesNo

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

YesNo

Address of Pool

Street Address

Street Address Line 2

CityState

Zip Code

1234

Swimmer's Name*

MaleFemale

Swimmer's Age*

Swimmer's Birthday*

Date

Swimmer's Ability*

Length of class that you prefer for this swimmer *

Is there anything additional that you would like me to know about this swimmer?

2nd Swimmer's Name*

MaleFemale

2nd Swimmer's Age*

2nd Swimmer's Birthday*

Date

2nd Swimmer's Ability*

Length of class that you prefer for this swimmer *

Is there anything additional that you would like me to know about this swimmer?

3rd Swimmer's Name*

MaleFemale

3rd Swimmer's Age*

3rd Swimmer's Birthday*

Date

3rd Swimmer's Ability*

Length of class that you prefer for this swimmer *

Is there anything additional that you would like me to know about this swimmer?

4th Swimmer's Name*

MaleFemale

4th Swimmer's Age*

4th Swimmer's Birthday*

Date

4th Swimmer's Ability

Length of class that you prefer for this swimmer *

Is there anything additional that you would like me to know about this swimmer?

What day would you like to start swim lessons?*

Date

How many classes would you like to sign up for?*

MondayTuesdayWednesdayThursday

Is there anything that I need to know about the pool where the swim lessons will be taught?*

We occasionally take pictures of the kids in action swimming

or doing other activities for our Facebook Page.

We hope to use these to show other parents what we do and what our swim lessons look like.

YesNo

If you were referred by a friend please let us know who, so we can thank them!

The amount owed will be due after the first class and can be paid by cash, check, Venmo or Zelle. You are free to pay for each class seperately or packages can be purchased.

CANCELLATION POLICY

In the case that classes are cancelled due to inclement weather, we will attempt to reschedule at the next available date and time. If we are unable to reschedule for wahtever reason, a refund will be issued for the class missed.

If the instructor needs to cancel a class for any reason, the class can either be rescheduled at a later date or a refund will be issued for the missed class.

WAIVER AND RELEASE OF LIABILITY

PLEASE READ CAREFULLY BEFORE ACCEPTING. THIS IS A RELEASE AND WAIVER OF CERTAIN LEGAL RIGHTS.

I, {parentsNames}, being the parent/legal guardian of the child/children named above, {swimmersName}, {2ndSwimmers},{3rdSwimmers}, {4thSwimmers}, (the "Participant(s)"), on behalf of myself and the Participant(s), voluntarily consent to have the Participant(s) attend and participate in Bubbles and Kicks ("Bubbles and Kicks") swimming lessons. I am aware of the risks to person and property known to be associated with swimming lessons and the swimming facility including, but not limited to, the dwelling structure, the pool, gates, diving board, steps, equipment, foliage, insects, parking and surrounding areas. I understand that swimming is a potentially hazardous activity and there are risks inherent to swimming that include but are not limited to: injuries, broken limbs, cuts, paralysis, illness and even death. Knowing the risks, and in consideration of the Participant(s) participating in swim lessons, I hereby agree to assume all risks related to such participation and hereby further release and agree to indemnify and hold harmless Bubbles and Kicks and its instructors, owners, officers, agents and employees from any and all liabilities, claims, demands and causes of action whatsoever arising from, relating to or attributable to any loss, damage or injury, including death, that may be sustained or suffered by Participant(s) while participating in, or travelling to or from, swim lessons— including any such liabilities, claims, demands or causes of action arising out of Bubbles and Kicks' or its instructors' negligence or gross negligence. I agree to indemnify and hold harmless Bubbles and Kicks and its coaches, owners, officers, agents and employees from and against any and all damages, costs and expenses (including, but not limited to, costs of any treatment or medical care, reasonable attorneys' fees and court costs) incurred by them arising from any claims, demands or causes of action by or on behalf of the Participant (including any claims, demands or causes of action arising out of Bubbles and Kicks' or its instructors' negligence or gross negligence).

I hereby authorize any representative of Bubbles and Kicks to have the Participant(s) treated in any medical emergency during his or her participation in swim lessons. Further, I hereby agree to pay all costs associated with medical care and transportation for the Participant(s) in connection with any medical emergency.

I acknowledge that I have thoroughly read this waiver and release and fully understand that is a release of liability. By signing this document, I am waiving any right I or my successors might have to bring a legal action or assert a claim for and on behalf of myself or the Participant(s) against Bubbles and Kicks as detailed in the first paragraph of this Waiver and Release.

Yes

Signature

Date

Bubbles and Kicks Mansfield