• After-school Enrollment Form

    After-school Enrollment Form
  • Program of Interest*
  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender
  • Is the applicant bilingual/multi-lingual?
  • Please select the kind of registration you are applying for:
  • Family Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Medical and Health Information

  • Is your child taking any medications at home or at school or have allergies?
  • Medication

  • Do you require an EpiPen for your child?
  • Acknowledgement, Authorization, and Consent

  •  

    THE NEW YORK SWIM ACADEMY
    Aquatic Program Consent & Safety Acknowledgment
    1. Participation Consent
    I authorize my child to participate in The New York Swim Academy's aquatic programs, including:

    Swimming instruction and water-safety education
    Pool activities and aquatic games
    Water polo and related physical activities, where applicable
    I understand that aquatic activities involve inherent risks, including slipping, falling, collisions, accidental submersion, and water-related injuries.

    2. Medical Information
    I confirm that:

    I have provided accurate information about my child's relevant medical conditions, allergies, medications, and physical limitations.
    I have disclosed my child's swimming ability and any relevant safety concerns.
    I will notify NYSA of changes that may affect my child's safe participation.


    3. Emergency Medical Authorization
    In the event of illness or injury, I authorize NYSA personnel to:

    Contact emergency medical services when necessary.
    Notify me or my designated emergency contact.
    Seek appropriate emergency medical care if I cannot be reached and urgent care is needed.
    I understand that I may be responsible for applicable medical expenses, subject to applicable law and insurance coverage.

    4. Aquatic Safety Rules
    I acknowledge that:

    My child must follow all instructor directions and facility safety rules.
    I am responsible for accurately reporting my child's swimming ability.
    Participation does not guarantee swimming proficiency or eliminate the need for appropriate supervision.
    NYSA may restrict or suspend participation when reasonably necessary to address safety concerns.


    5. Assumption of Risk & Liability Release
    I understand that swimming, water polo, and other aquatic activities involve inherent risks, including potentially serious injury.

    I acknowledge these inherent risks associated with my child's participation.
    Any release of liability will apply only to the extent permitted by applicable law and as expressly stated in a legally enforceable agreement.
    Nothing in this acknowledgment waives rights or claims that cannot legally be waived.
    6. Parent/Guardian Acknowledgment
    I confirm that:

    I am the participating child's parent or legally authorized guardian.
    The information I have provided is accurate to the best of my knowledge.
    I have read and understood this consent and safety acknowledgment.
    I understand the program's participation requirements and safety expectations.
    I agree to notify NYSA of relevant changes to my child's medical or emergency information.

     

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • *
  • Should be Empty: