Intake Form - All Aqua

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Swimmer 1: Name* This field is required.If siblings - please type in both names
First Name
Last Name
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Swimmer 1: Date of Birth* This field is required.
Date
Day
Month
Year
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Swimmer 1: Medical Information* This field is required.Please let us know if your child has any medical conditions, allergies, or injuries we should be aware of.
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Large
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Small
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Ok
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Swimmer 1: Additional Needs, Neurodivergence & Disabilities* This field is required.Does your child have any additional needs, learning differences, physical disabilities, or display any signs that would be helpful for us to know? This might include things like attention differences, sensory sensitivities, mobility or coordination challenges, communication differences, or anything else you’ve noticed — whether formally assessed or not. We work with many children with and without assessments. Sharing any small details helps us create a safe, supportive, and effective learning environment for your swimmer!
No additional needs or assesments
Undiagnosed / still exploring / awaiting assessment
Physical disability or motor delays
Autistic
ADHD
Dyspraxia
Sensory processing differences
Anxiety or other emotional regulation challenges
Speech, language, or communication delays
Learning difficulty (e.g. dyslexia, dyscalculia)
Cognitive or developmental delay
Behavioural differences
Prefer not to share
Other (please fill in next page)
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Swimmer 1: Additional needs, neurodivergence, disabilities ... Cont'd.Please provide more information here
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Large
Normal
Small
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Ok
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Do you have a 2nd Swimmer?
YESNO
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Swimmer 2: Name
First Name
Last Name
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Swimmer 2: Date of Birth
Date
Year
Month
Day
9
Swimmer 2: Medical Information* This field is required.Please let us know if your child has any medical conditions, allergies, or injuries we should be aware of.
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Large
Normal
Small
Ok
Ok
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Swimmer 2: Additional Needs, Neurodivergence & Disabilities* This field is required.Does your child have any additional needs, learning differences, physical disabilities, or display any signs that would be helpful for us to know? This might include things like attention differences, sensory sensitivities, mobility or coordination challenges, communication differences, or anything else you’ve noticed — whether formally assessed or not. We work with many children with and without assessments. Sharing any small details helps us create a safe, supportive, and effective learning environment for your swimmer!
No additional needs or assessments
Undiagnosed / still exploring / awaiting assessment (please fill in next page)
Physical disability or motor delays
ADHD
Oppositional Defiance Disorder
Autism
Asperger's
Dyspraxia
Sensory processing differences
Anxiety or other emotional regulation challenges
Speech, language, or communication delays
Learning difficulty (e.g. dyslexia, dyscalculia)
Cognitive or developmental delay
Behavioural differences
Other (please fill in next page)
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Swimmer 2: Additional needs, neurodivergence, disabilities ... Cont'd.Please provide more information here
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Large
Normal
Small
Ok
Ok
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Do you have a 3rd Swimmer?
YESNO
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Swimmer 3: Name
First Name
Last Name
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Swimmer 3: Date of Birth
Date
Year
Month
Day
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Swimmer 3: Medical Information* This field is required.Please let us know if your child has any medical conditions, allergies, or injuries we should be aware of.
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Large
Normal
Small
Ok
Ok
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Swimmer 3: Additional Needs, Neurodivergence & Disabilities* This field is required.Does your child have any additional needs, learning differences, physical disabilities, or display any signs that would be helpful for us to know? This might include things like attention differences, sensory sensitivities, mobility or coordination challenges, communication differences, or anything else you’ve noticed — whether formally assessed or not. We work with many children with and without assessments. Sharing any small details helps us create a safe, supportive, and effective learning environment for your swimmer!
No additional needs or diagnoses
Undiagnosed / still exploring / awaiting diagnosis (please fill in next page)
Autistic
ADHD
Dyspraxia
Sensory processing differences
Anxiety or other emotional regulation challenges
Speech, language, or communication delays
Physical disability or motor delays
Learning difficulty (e.g. dyslexia, dyscalculia)
Cognitive or developmental delay
Behavioural differences
Other (please fill in next page)
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Swimmer 3: Additional needs, neurodivergence, disabilities ... Cont'd.Please provide more information here
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Large
Normal
Small
Ok
Ok
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Parent 1: Name* This field is required.
First Name
Last Name
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Parent 1: Phone Number* This field is required.
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Parent 1: Email* This field is required.
example@example.com
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Parent 2: Name* This field is required.If there is no second parent involved, please provide the name of any additional caregiver's we may need to know
First Name
Last Name
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Parent 2: Phone Number* This field is required.
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Parent 2: EmailThis will be used as a second email for billing and lesson communication
example@example.com
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Emergency Contact:
(Ideally not a parent listed previously)

Name    First Name *     Last Name *
Phone Number       Phone Number *
Relation:    *
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Address* This field is required.Home Address
Street Address
Street Address Line 2
City
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Gate Code / Access InformationPlease enter any information we may need for your instructor to access your complex / home / pool.
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Terms & Conditions - Enrollment* This field is required.Enrollment: • This Terms & Conditions Form must be signed digitally prior to the commencement of lessons. • All-Aqua Limited (the “Company”) provides lessons on a term basis, the exact details of which can be located on the (annual calendar) (the “Term”). • New clients are able to pay for their first lesson upfront before committing to the full Term, to ensure they are happy with the instructor, timing, and overall fit. • Confirmation of continuing enrollment must be given two weeks prior to the end of the current Term (not including half term breaks). • A CI$10 admin fee per family is applied each Term to support scheduling, communication, and operational systems. • These Terms & Conditions are subject to change at the discretion of the Company. The most current version will always be published on our website, and continued enrollment will be deemed acceptance of the updated Terms.
I have carefully read the Terms & Conditions and agree to them in full.
Other
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Terms & Conditions - Payment Policy* This field is required. Payment Policy • No lesson will be held without confirmed Payment of the Term. Any unpaid Lessons may be released to the waitlist. • A late payment fee of CI$50 will be applied if payment is not received by the due date or once two lessons have occurred without payment, even though payment is expected in advance. • If you choose to cancel or adjust your booking partway through the term (based on your own schedule, not an instructor’s decision), any remaining lessons are only redeemable within the same term. A CI$25 fee will be charged for additional administrative work/ late term changes. • The Company does not offer refunds for missed, unused, or cancelled lessons. In cases where a lesson must be cancelled, a credit may be issued at the Company’s discretion, redeemable within the same term. • Payment plans may be offered on a case-by-case basis. These must be agreed upon in advance. If a payment plan is not honored, we reserve the right to cancel remaining lessons and release your space. • Fees are subject to change at the discretion of the Company. • The Company does not offer refunds for missed or unused lessons unless otherwise stated.
I have carefully read the Terms & Conditions and agree to them in full.
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Terms & Conditions - Makeup / Cancellations* This field is required.Make-Up / Cancellation Policy • Each Full-Term client is entitled to one make-up lesson per Term. • To be eligible for a make-up, 24 hours’ notice is required via email or WhatsApp. • The same 24-hour cancellation rule applies to any make-up lesson. • Lessons cancelled by an instructor will either be covered by a substitute, rescheduled, or credited within the same Term. Credits will not be carried forward unless otherwise agreed in writing. • Credits hold no cash value, are not transferable between swimmers, and must be used within the same Term. If you do not re-enroll, any remaining credits will be forfeited. • Pre-planned absences may be accommodated by pre-scheduling a make-up or applying a credit in advance, subject to availability. This must be arranged before the start of the Term. • Goodwill credits may occasionally be offered at the Company’s discretion. These are not guaranteed, do not roll over, and cannot be transferred or applied to future terms unless explicitly agreed in writing. • In cases of medical or family emergencies, the Company will determine whether lessons may be rescheduled or credited. • The Company does not provide refunds for cancelled or unused lessons under any circumstances.
I have carefully read the Terms & Conditions and agree to them in full.
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Terms & Conditions - Pool Conditions* This field is required.Pool Conditions • Pools must be properly maintained prior to lessons, with a minimum water temperature of 76℉ (24.5℃), safe pH and chlorine levels, no algae, and free from debris. • It is the client’s responsibility to ensure the pool meets these conditions before each scheduled lesson. • If the pool is deemed unsafe or unteachable (including incorrect water chemistry, excess debris, poor visibility, or insufficient temperature) at the time of the lesson or within 24 hours prior, the session will be forfeited and not re-credited. • This policy also applies following storms, hurricanes, or severe weather where the pool remains in an unteachable state.
I have carefully read the Terms & Conditions and agree to them in full.
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Terms & Conditions - Weather* This field is required.Weather Policy • Lessons canceled due to storms, lightning, hurricanes, road closures, or other uncontrollable events (Acts of Nature) will not be rescheduled, refunded, or credited. • We swim in the rain. Please ensure swimmers wear appropriate attire, such as a warm wetsuit during cooler months. • Instructors will be monitor lightning storms and lessons, they may be shortened or cancelled as a result. Lessons shortened or cancelled by lightning will not be made up or issued credits. • Only your instructor will confirm a weather cancellation. If you are not contacted, please assume your lesson will proceed as scheduled. • The Company will adhere to all Inclement Weather School Closures as implemented by the Ministry of Education or Government by cancelling lessons to avoid driving in unsafe conditions. If lessons are canceled due to hurricanes, natural events, or road closures beyond the Company's control, they will not be rescheduled or receive a credit
I have carefully read the Terms & Conditions and agree to them in full.
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Terms & Conditions* This field is required.Adult Swim Policy • Term dates will be confirmed by your instructor in advance. • Due to the short format and group dynamic, we maintain a strict zero-cancellation policy for adult group swims. This ensures consistency and progress for all members. • If a participant is unable to attend a scheduled lesson, their space cannot be transferred to another swimmer, unless expressly approved by the Company and only if the replacement swimmer is of the same ability level. • Consistent attendance is expected. If a participant’s repeated absences disrupt the group’s progress, the Company reserves the right to remove them from the group without refund or credit.
I have carefully read the Terms & Conditions and agree to them in full.
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Liability Waiver* This field is required.PLEASE READ CAREFULLY. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS. • The enrolled participant(s) and/or the parent/guardian of the participant(s) understand and acknowledge that swimming is a hazardous activity. The Client recognizes that there are risks inherent in swimming lessons, including but not limited to serious injury, permanent disability, and death. The Client voluntarily assumes all risks, known and unknown, associated with participation. • The Client agrees to indemnify, release, and hold harmless All Aqua Limited, its instructors, owners, directors, management, agents, and employees from any and all liability, claims, or demands of any kind arising out of participation in the swim lesson program, except where liability cannot be excluded by law. • All Aqua Limited maintains professional indemnity insurance covering instructors and teaching practices. However, the Client acknowledges that All Aqua Limited shall not be liable for injuries, accidents, or claims arising from the nature, quality, or method of instruction, except where required by law. • The Client/Parent/Guardian signing this waiver affirms that they are legally authorized to act on behalf of the minor participant. • The participant authorizes any representative of All Aqua Limited to obtain emergency medical treatment for the participant during swim lessons if deemed necessary. The participant and/or parent/guardian accepts full financial responsibility for all medical care and related transportation costs arising from such treatment. • This waiver shall be governed by and construed in accordance with the laws of the Cayman Islands. If any provision of this waiver is found to be invalid or unenforceable, the remaining provisions shall continue in full force and effect.
I have carefully read the Liability Waiver and I am signing with full knowledge of its contents and significance.
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Photo Permissions / Consent* This field is required.At All Aqua, we love celebrating our swimmers’ progress and sharing special moments with our Swim Family community. Photos and videos may occasionally be taken during lessons and events to be shared on our social media, website, or other marketing platforms. We are mindful of how and when we use these images, and we will never share identifying information without your consent. You can change your choice at any time by letting us know in writing, and we will fully respect your decision.
YesNo
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