Summer 2026 Swim Lesson Registration Form
To help us provide opportunities for as many families as possible, please select only ONE location per participant.
Child’s Name (If you have multiple children, please submit another form)
*
First Name
Last Name
Child’s Age
*
Child’s Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Classes are held at three locations: Bellemeade Pool, Cobblestones Water Park, and NOVA of Virginia Aquatics. Please choose the location you will attend and submit only one child per form.
Bellemeade Pool | 1800 Lynhaven Avenue, Richmond, VA 23224
Start date: Tuesday, June 2, 2026
Location
*
Bellemeade Pool
Cobblestones Water Park
NOVA of Virginia Aquatics
Bellemeade Session — Starts Tuesday, June 2, 2026
*
Tues & Thurs, 5:00pm–5:45pm — 6-week session {18}
Cobblestones Water Park | 13131 Overhill Lake Ln, Glen Allen, VA 23059
Start date: Tuesday, June 2, 2026
Cobblestones Session — Starts Tuesday, June 2, 2026
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Tues & Thurs, 6:00pm–7:00pm — 6-week session {18}
NOVA of Virginia | 12207 Gayton Rd, Richmond, VA 23238
Session 1: June 1–June 11, 2026 (Monday–Thursday for 2 weeks) — choose class time
*
10:00am–10:45am — {6} spots available
10:45am–11:30am — {6} spots available
11:30am–12:15pm — {6} spots available
12:15pm–1:00pm — {6} spots available
Session 2: June 15–June 25, 2026 (Monday–Thursday for 2 weeks) — choose class time
*
10:00am–10:45am — {6} spots available
10:45am–11:30am — {6} spots available
11:30am–12:15pm — {6} spots available
12:15pm–1:00pm — {6} spots available
Session 3: June 29–July 9, 2026 (Monday–Thursday for 2 weeks) — choose class time
*
10:00am–10:45am — {6} spots available
10:45am–11:30am — {6} spots available
11:30am–12:15pm — {6} spots available
12:15pm–1:00pm — {6} spots available
Session 4: July 13–July 23, 2026 (Monday–Thursday for 2 weeks) — choose class time
*
10:00am–10:45am — {6} spots available
10:45am–11:30am — {6} spots available
11:30am–12:15pm — {6} spots available
12:15pm–1:00pm — {6} spots available
Swim Level (choose the best match for your swimmer)
*
Beginner
Intermediate
Advanced
Other
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Conditions or Special Needs (if any)
Waiver and Release of Liability
Reel Em In Liability Waiver
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 of Parent/Guardian
*
Register
Register
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