Camp Enrollment Form

Registration

Let’s get ready for camp!This form takes about 5–10 minutes and includes parent and camper information, emergency contacts, permissions, and camp policies. You’ll also select your child’s session by age. Please remember to fill out this form per swimmer if you have multiple kids you are enrolling. A $20 registration fee is due when submitting. Need help or have questions? Reach out anytime using the number below!

Meet the Owner of Madison Swim Academy
Hi! I’m Cassidy Floyd, owner and instructor. As a wife and mom, I believe swimming is one of the most important life skills a child can develop.
Madison Swim Academy was built around a simple principle: children learn best by being in the water. Lessons and programs are intentionally structured to maximize meaningful, guided water time so swimmers can build confidence, develop skills efficiently, and make steady progress.
Water safety is at the heart of everything we do. Our goal is to help children feel confident, capable, and safe in and around the water.
Thank you for trusting us with your swimmer 💙

Parent/ Guardian Name*

First NameLast Name
Phone Number (We reach out through text. If you have registered, please expect a text message from (938)653-3262.)*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CHILD NAME 1*

First NameLast Name
Child 1 Birthday*

MonthDayYear
Date

EMERGENCY CONTACT INFORMATION
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.
Medical Information: Known Allergies? Chronic Medical Conditions? Neurological Disorders? Current Medications? Other Special Needs?
Preferred Hospital/ Medical Facility
Preferred Hospital/ Medical Facility Phone
Please enter a valid phone number.
Preferred Hospital/ Medical Facility Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Media Release
Dear Parent/Guardian,

Madison Swim Academy would like your permission to use images and videos taken of you/ your child to showcase their swimming abilities on our website, social pages, and in our promotional ads.

We are hoping to make reels/ short videos this year to grow our business and to offer the opportunity for others to learn to swim and to share with others the importance of water safety.

We recognize the need to ensure the welfare and safety of all young people taking part in any activity associated with our organization. We will not mention names or locations to keep everyone as safe as possible.
Sign Here*

First NameLast Name

Swim Policy & Liability Waiver
I acknowledge that invoices will be sent out 10 days before the camp start date. If invoices are not paid, the spot will be given to someone on the waitlist and you will forfeit your $20 Registration Fee. All families are required to pay a $20 Registration Fee per child when submitting this form as it holds their spot on our schedule. Payments are handled through Square, providing secure, reliable, and professional transaction processing. You can pay through square or you can pay with cash but if using cash message us to let us know beforehand. *
Initial
At Madison Swim Academy, we do not offer refunds for missed or canceled days, unless the day was canceled by the school. Medical Exemptions: If a child is unable to continue lessons due to a medical condition (uncontrollable crying is not a medical condition) or injury, refunds will be considered on a case by case basis with confirmed documentation from a doctor.*
Initial
Please note: Each family is scheduled at specific times and days. Please select the correct date and time according to age.*
Initial
Age Misrepresentation Policy: Accurate age disclosure is required for safety and program placement. If it is discovered that a child's age was misrepresented the child will be removed from the schedule, a partial refund will be issued, 25% of all paid tuition will be retained to cover reserved time and administrative costs. This policy is non-negotiable.
Type Age(s) Here and Initial
Weather Policy: Lessons are held in light rain. We will postpone in the event of thunder, lightning, or unsafe conditions. We are required to remove students out of the water if lightning is 15 miles away.*
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What to Bring: Swimsuit, towel, sunscreen, and any comfort item your child may need. Goggles are optional... If you bring goggles, your instructor may do a few lessons without them (because you won't always have goggles if you have an accident near water.)Please arrive ready to swim. *
Initial
I acknowledge that Madison Swim School follows the same sickness standards as a public school. We deal with lots of children and have young ones at home. Please reschedule if child has a fever, vomiting, diarrhea, or any contagious illness. Clients should notify us as soon as possible if their child is unwell. If a child is brought in sick to a lesson, the child will be removed from the schedule, a partial refund will be issued, 25% of all paid tuition will be retained to cover reserved time and administrative costs. This policy is non-negotiable.*
Initial
I acknowledge the policies and acknowledge Madison Swim Academy reserves the right to refuse service or remove a swimmer from a session for safety concerns or repeated non-compliance with policies. That includes: not sitting on the steps between skills, jumping in the water without permission, crying for more than 10 minutes, not listening to instructor, and not trying.*
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Liability Waiver: l, the undersigned, hereby acknowledge and agree that participation in swim lessons with Madison Swim Academy involves inherent risks, including but not limited to injury, drowning, or death. I assume full responsibility for any and all risks associated with my child’s participation in these lessons. I release and hold harmless Madison Swim Academy (including all instructors, contractors, volunteers, and/ or property owners of the swim lesson locations) from any liability, claims, or actions of any kind for any injury, loss, or damage that may arise from participation in swim lessons, whether caused by negligence or otherwise. I have read, understand, and agree to abide by the policies listed above. I acknowledge that I am the legal parent or guardian of the child named above and have the legal authority to sign this agreement.*
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Signature*

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CHOOSE YOUR DATES & TIMES

Select your child’s camp week and session time. Be sure your selection is correct prior to submission. Camp sessions fill quickly, and transfers between sessions may not be available.
Week 1: May 18-22
Week 2: May 25-29

Payment.

Camp Registration Fee

Per child (Waived until March 4, 2026)

$ Free Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Email*
example@example.com

Should be Empty:

Registration

Meet the Owner of Madison Swim Academy

EMERGENCY CONTACT INFORMATION

Media Release

Swim Policy & Liability Waiver

CHOOSE YOUR DATES & TIMES

Payment Methods