Schroeder Diving Lessons

2022 Schroeder Dive Lessons Fall Session 2 - Wednesday

Wednesday Session - 6:00-6:50 pm - November 2nd-December 14th, 2022 ***No Lessons November 23rd**
Diver Name*

First NameLast Name
Parents Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Diver's Age*
Has your child had dive lessons/camp at Schroeder before?*

YesNo
Phone Number/emergency contact*

Area CodePhone Number
E-mail*
Medical Release Waiver (check to agree)*

I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Walter Schroeder Aquatic Center to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment.I hereby waive, release and forever discharge Walter Schroeder Aquatic Center and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Walter Schroeder Aquatic Center activities, whether or not damages or loss is due to negligence. I hereby acknowledge that I / my children am / is (are) physically fit and capable of participation in all activities.
Liability Waiver (check to agree)*

By registering me / my child(ren) with the Walter Schroeder Aquatic Center, I agree to participate (or allow my child(ren) and family members to participate) in the Walter Schroeder Aquatic Center, and hereby release Walter Schroeder Aquatic Center, its directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the Walter Schroeder Aquatic Center program, including travel to and from training sessions, competitions or other scheduled team activities.I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child(ren) or family members) participating in the Walter Schroeder Aquatic Center program.
Payment preference*

Pay $110 with check on first day of class (Leave payment info unfilled below)Pay with credit card now (complete credit info below)

Credit Card Payment Info

Schroeder Dive Lessons $110.00

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2022 Schroeder Dive Lessons Fall Session 2 - Wednesday