Summer 2025 Swim Lesson Registration Form

Classes wil be held at three different locations:

City of Richmond, VA at the Bellemeade Pool on Tuesdays and Thursdays from 5pm to 5:45pm (6wk sessions)

Cobblestone Water Park on Tuesdays and Thursdays from 6pm to 7pm (6wk sessions)

NOVA of Virginia Aquatics: 5 different sessions - sessions are Mon-Thurs for 2wks per session

Please choose location to attend lessons and submit only one child per form.

Bellemeade Pool | 1800 Lynhaven Avenue, Richmond, VA 23224

Cobblestone Water Park I 13131 Overhill Lake Ln, Glen Allen, VA 23059

NOVA of Virginia l 12207 Gayton Rd, Richmond, VA 23238

Yes, my child has had prior lessons and knows a few strokes. (Advanced)Yes, my child loves the water, but needs help with strokes (Intermediate)Yes, my child is comfortable but doesn't like to go underwater (Beginner)Yes, my child has had lessons, but has a fear of water. (Beginner)No, my child has not had lessons but loves the water. (Intermediate)No, my child has not had lessons, and is not comfortable in the water (Beginner)No, my child doesn't like the water, but I want them to learn to swim. (Beginner)Other

Parent Name*

First NameLast Name

Child Name (If you have multiple children, please submit another form.)*

First NameLast Name

Child's Age

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Assumption of Risk and Waiver of Liability: Swimming, like all athletic activities, involves elements of risk to participants, and can be a challenge for some persons. In consideration of my being allowed to participate in the Reel ‘Em In, inc. (REI) swimming lessons program at Cobblestones Water Park, 13131 Overhill Lake Lane, Glen Allen, VA and/or any similar host site, the participants and their parent(s)/guardian(s), for themselves and their families, heirs, administrators, estates and executors, voluntarily agree to assume all inherent risks incidental to swimming lessons, and agree that Reel ‘Em In, its members/owners, employees, agents, sponsors, volunteers, instructors, the owners of the host site(s), and their successors and/or assigns (“REI”), are not liable for, and I/we hereby release REI from any and all claims for costs, injuries, damages, and/or death to the fullest extent allowed by the law resulting from those swimming lesson programs/activities, even if arising from ordinary negligence of REI.

Participants and/or spectators agree to observe all rules of Reel ‘Em In and of the host site(s) where/when the swim lessons are held.

Permission is given to Reel ‘Em In to utilize your video or photo image or likeness for Reel ‘Em In promotional purposes when obtained incidental to any event.

Medical Certification & Release: I certify that the Participant is in good physical health, and has no medical condition(s) that would prevent full participation in the outlined activities and programs. In the event of any medical emergencies, I authorize Reel ‘Em In to take whatever actions it deems necessary (including transport for medical service providers), and I agree to assume full responsibility for all costs associated therewith.

I have read and fully understand (including that I am giving up legal rights/remedies which may be available to me) and voluntarily agree to each of the above items.

Signature

Date

Swim Lesson Registration Form

Reel Em In Liability Waiver