Swim Baby Swim Cleveland – Lesson Registration

Swim Baby Swim Cleveland – Lesson Registration

Register your child for swim lessons and share key safety/support information for our instructors. Payment is expected after the time and date will be confirm via email. An invoice will be sent afterwards. Do not fill this out if your using grants or other funding.
Parent / Guardian Information
Parent / Guardian Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Schedule
Preferred Days
Preferred Time of Day
Preferred Session Start Date

MonthDayYear
Date
Lesson Type
Preferred Location
Please note: A member of the Swim Baby Swim Cleveland team will reach out to confirm available dates and times with your family before your first lesson. Payment will be needed to start. Submitting this form does not guarantee a specific time slot.
No Refund Policy
Child 1 Information
Child's Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender
Swimming Ability Level
Child 2 Information
Child 2 Full Name

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Date
Child 2 Gender
Child 2 Swimming Ability Level
Child 3 Information
Child 3 – Full Name

First NameLast Name
Child 3 – Date of Birth

MonthDayYear
Date
Child 3 – Age
Child 3 – Gender
Child 3 – Swimming Ability Level
Health & Medical Information
Does the child have any medical conditions we should be aware of?
If yes, please describe the medical condition(s)
Does the child have asthma or any respiratory condition?
Does the child have any heart-related conditions?
Does the child have autism, ADHD, or another neurodevelopmental condition we should be aware of?
If yes, please share anything that would help us support the child best
Does the child have any allergies?
Additional notes for the instructor
Waiver & Consent
I understand that swimming carries inherent risks and I agree to the terms and conditions of participation at Swim Baby Swim Cleveland.
Do you give permission for photos or videos of the child to be used on Swim Baby Swim Cleveland's social media or website?
Electronic Signature
Date

MonthDayYear
Date
Should be Empty:

Swim Baby Swim Cleveland – Lesson Registration

Parent / Guardian Information

Preferred Schedule

Child 1 Information

Child 2 Information

Child 3 Information

Health & Medical Information

Waiver & Consent