New Swimmer Registration Form

Full Name (of participant)*

First NameLast Name

Name of Parent or Guardian (if applicable)

First NameLast Name

Date of Birth (of Participant)*

Date

Street Address

Phone Number*

Please include country codes

E-mail*

example@example.com

Which Lessons are you interested in?*

We teach all ages & levels, please specify which one(s) you are interested in.

What language(s) does the swimmer speak?

Explain your swimmers current level:

Beginner? Can float? Go underwater? Swim a few meters without floatation? Passed any certificates/diplomas?

Preferred Day(s) & Time(s)

How did you hear about us?*

PLEASE READ THROUGH AND SIGN.

By signing this form, I hereby affirm that I am aware that all conducted activities at Aqua Windie’s have inherent risks which may result in serious injury or death.

I understand and agree that neither the instructor's, Aqua Windie’s, nor any of their respective employees (hereinafter referred to as ‘Released Parties’) may be held liable or responsible in any way for any injury, disease, pandemic, death or other damages to me, my family, estate, heirs or assigns that may occur as a result of my participation in conducted activities at Aqua Windie’s or as a result of the negligence of any party, including the Released Parties, whether passive or active.

In consideration of being allowed to participate in any activity, I hereby personally assume all risks of this program, whether foreseen or unforeseen, that may befall me while I am a participant in any activity.

I further release, exempt and hold harmless said activities and Released Parties from any claim or lawsuit by me, my family, estate, heirs or assigns, arising out of my enrollment and participation in any activity at Aqua Windie’s.

I also understand that any activity conducted at Aqua Windie’s can be physically strenuous and that I will be exerting myself during any activity, and that if I am injured as a result of heart attack, panic, hyperventilation, drowning, pandemic or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same.

I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this Agreement of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree that if any provision of this Agreement is found to be unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the un-enforceable provision had never been contained herein.

I understand and agree that I am not only giving up my right to sue the Released Parties but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Parties resulting from my death. I further represent I have the authority to do so and that my heirs, assigns, or beneficiaries will be estopped from claiming otherwise because of my representations to the Released Parties.

Signature*

Today's Date*

Date

Swimmer Details: