Make a Splash Application

PLEASE READ THIS CAREFULLY BEFORE PROCEEDING:

The Make a Splash program at TAC offers reduced-cost swim lessons to families facing financial hardship. Cost is $20 for a 6-lesson package.

To qualify for the Make a Splash, the child applying (or child’s sibling) must participate in the Free/Reduced meal program through Wake County Schools.

You must upload qualifying documentation in order to complete this application.

You will be notified regarding the status of your application and next steps will be provided.

Once enrolled, consistent attendance is expected. Excessive absences may result in termination.

If you have more than TWO swimmer in your family, please include this in your notes.

All swim lessons take place at the Triangle Aquatic Center, located at 275 Convention Drive, Cary NC 27511.

Swimmer's Name*

First NameLast Name

Swimmer's Age*

Swimmer's Birthdate*

Date

Is there 2nd swimmer to add to this application?*

YesNo

2nd Swimmer's Name*

First NameLast Name

2nd Swimmer's Age*

2nd Swimmer's Birthdate*

Date

Parent / Guardian*

First NameLast Name

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Phone Number*

Please enter a valid phone number.

Parent/Guardian Email*

Confirmation Emailexample@example.com

Emergency Contact Name*

First NameLast Name

Emergency Contact Relationship*

Emergency Contact Phone Number*

Please enter a valid phone number.

Wake County Free or Reduced Lunch Program Letter*

Anything you'd like us to know about this applicant?

By signing below, I hereby recognize and acknowledge that my or my child’s participation in recreational activities may involve bodily and/or emotional injury to myself and/or my child.

In consideration of myself and my child being able to participate in such events, I, for myself, child(ren), heirs, executors and administrators, hereby voluntarily and knowingly indemnify and hold harmless, defend, release, waive, and discharge Triangle Aquatic Center and its officers, employees and volunteers from any and all suits, claims or liability, including negligence. I therefore will cover all medical, hospitalization or any other expenses resulting from my or my child’s participation.

I herby authorize Triangle Aquatic Center staff to act on my behalf in accordance with their best judgment in case of an emergency involving me or my child, and agree to assume full responsibility for all expenses, medical or otherwise, that may arise there from.

PHOTO RELEASE: I authorize Triangle Aquatics to use my image taken in classes for publicity purposes.

Signature*

Application: Make a Splash