Swim Lessons Registration

1
Please check your vacation, school, and apointment schedule before registering for swim lessons.

Please note- if you are gone for vacation at any time, you are responsible for paying that week, as well as any additional weeks (after 6 weeks) if your child needs more time. Please let Darsey know BEFORE signing up for any time you are planning to miss.

Classes are 4 days a week. Mon-Thur, and are 10 minutes per day.

Scheduling is done through Darsey.

Registration fee:

$100 for 1 child or if registering more than 1 child together, $150.00 (50.00 each additional). THIS IS NON REFUNDABLE.

Returning clients must pay $50.00 to hold their time, this in NON-REFUNDABLE. This secures your start date and time with the instructor.

Weekly Tuition:

$90/ per week per child

The program is $540.00 in total and 6-8 weeks in length.

Late fee- $20.00 will be applied if not paid on time weekly.

**If your child is finished before 6 weeks -you can maintain your time for additional practice, building confidence , diving etc. If you choose to be finished the balance of program fees will be due. **

If your child needs additional time beyond the 6 week program, this will be an additional $90.00 per week

Maintenance lessons:

One day lessons are $25.00 per lesson.

Parent/Caregiver in water lessons/guidance:

I will be scheduling these lessons seperate from weekly scheduled lessons.

If you would like to schedule a 20 min in water with me to go over basic skills to work with your child ongoing after they complete the program. Additional fees are applied.

20 min in water- $45.00

This will be scheduled upon request near the end of your child/children's completion of the program if requested.

If you do not finish the program, or have to quit for any reason, your fees/tuition paid will not be credited for future lessons, and your balance remaining will be applied to your account. No lessons in the future will be scheduled until balance is brought to current.

The registation fee must be paid within 24 hours of scheduling. The registration fee is non-refundable. Failure to recieve payment may result in time being forfeited.

Registration fee can be paid via venmo, paypal, cash or check mailed to 140 Faulkner Mtn Rd., Edgefield, SC 29824.

DO NOT FILL OUT THIS FORM UNTIL YOU HAVE SCHEDULED WITH DARSEY.
2
Type a questionI have read and understand all scheduling, registration fees, program fees, and lesson layout on previous screen of this form.
YESNO
3
Did you schedule lesson time with Darsey already?
Yes
No
4
Parent(s) Name(s)* This field is required.
5
Relationship to student?
6
Email Address* This field is required.
7
Contact Number* This field is required.
8
Parent 2 Email address
9
Parent 2 Contact Number
10
Do you receive Text at this number? Only used for notifications and inclement weather* This field is required.
Yes
No
11
Child Name* This field is required.
12
Swimmer's Gender* This field is required.
Male
Female
13
Swimmer's Birthday* This field is required.
14
Prior Experience with Survival Swim* This field is required.
New Student
Refresher
3rd year
15
Has swimmer #1 ever seen a medical specialist or had any non-routine health or behavioral issues? Please explain, if yes
16
Swimmer #1 prior swim/water experience.
17
Do you have a pool, live on the water (canal/lake/open water) have a boat?Please check all that apply
Pool
Open Water
Canal
Lake
Boat
None
18
What did swimmer 1 previously learn with survival swim lessons?
Float
Swim/float
Stroke
Swim/Float/Swim
Does not apply
19
Student #2 Name
First Name
Last Name
20
Swimmer's Gender* This field is required.
Male
Female
21
Swimmer's Birthday* This field is required.
22
Prior Experience with Survival Swim* This field is required.
New Student
Refresher
3rd year
23
Has swimmer #2 ever seen a medical specialist or had any non-routine health or behavioral issues? Please explain, if yes
24
Swimmer #2 prior swim/water experience.
25
Please click yes if you WILL give permission to have photographs of your child taken* This field is required.
Yes
No
26
Release of Liability: I release and hold Little Fish Survival Swim, LLC and it's owners and instructors from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, injury, including death, that may be sustained by the participants and/or undersigned, while in or upon the premises under the control and supervision of Little Fish Survival Swim LLC, it's owners, operators, pool hosts, or in route to or from of the said premises. I also acknowledge, participation, in or completion of lessons in no way implies that the participants are drown proof or water safe and that as the parent or legal guardian of the participants, I am ultimately responsible for my child's safety in and around the water and must at all times ensure appropriate vigilant and persistent supervision.
27
I have read the above and agree
I agree
28
Assumption of Risk: I understand, agree, and acknowledge that there are risks inherent in sports activties conducted by Little Fish Survival Swim, LLC and it's instructors. These activities may be hazardous nature and/or may include swimming, diving, and a variety of strenous excercise and physical activities. With the full understanding of the facts, I state to best of my knowlege, the participants I am registering have no medical, physical, or emotional conditions that would hinder or prevent safe participation in Little Fish Survival Swim, LLC.
29
I have read the above and agree
I agree
30
Enrollment Review and Payment Policies:I understand that I am enrolling for swim lessons with Little Fish Survival Swim LLC and that the information submitted on this enrollment form will require review as it is the intent of Little Fish Survival Swim LLC to provide each participant with an individualized, effective and safe learning experience. I acknowledge that in some health-related cases, Little Fish Survival Swim LLC may not be able to provide services. I certify that all medical/health information I have provided is correct and true and agree to provide additional information, including a physician’s clearance if requested, prior to the beginning of any lessons. I understand that in order to secure my child’s selected lesson time I must pay all applicable registration fees per the instructions sent to me. I understand that participant enrollment may be cancelled if payment is not received.
31
I have read the above and agree
I agree
32
How did you find us?* This field is required.
Facebook
Instagram
Google/Other search engine
Friend
Other
33
If you were referred by a friend please let us know who, so we can thank them!
34
Signature
35
Please type full name* This field is required.
36
Once you have scheduled your lesson time with Little Fish Survival Swim LLC, and filled out the registation form. Payment must be made within 24 hours to secure your time spot.

Registration fee can be paid by

Cash or check

Venmo or Paypal

Weekly Tuition can be paid the same way.

I also accept cash and check, but that must be scheduled and delivered for registation fee within 24 hours.
Should be Empty: