Cutri Swim Academy Registration

How Did You Find Us?*

Other:

CSA registration opens every year on February 1st at noon!

AVAILABILITY UPDATE:

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Dianne-AM lessons in Valrico: Lessons with Ms. Dianne at the Valrico location are booked until August. Only students who need no more than 4 weeks instructions need apply for the remaining August time slots.

Alanna-AM and PM lessons in Riverview: Mark your calendar now, registration opens at noon on February 1st each year.

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Please check your calendar before requesting your start date and time slot. Classes are held 4 days per week, only Monday through Thursday. New classes begin each Monday. No credit will be given for cancellations unless student illness or weather related. There will be no swim classes on Memorial Day, Labor Day or the week of Independence Day. PM lessons will not be held during July or August.

If you have not yet visited the Class Information page on our website, please do so now. Failure to do so may result in a delay in processing your registration.

Finally, remember that students should consume no dairy within 2 hours of the lesson and no food or drink within 1 hour of the lesson. This is very important for the safety and effeciency of your swim lessons.

Valrico Location: 3908 Appletree Dr. Valrico, FL 33594
Mornings with Dianne:
**Ms. Dianne's lessons are limited to students 6 mos. through 4 yrs. old

8:30 - 11:30 starting April 29
8:00 - 11:00 starting May 28 through August

Riverview Location : 7238 Alafia Ridge Loop Riverview, FL 33569
Mornings and Afternoons with Alanna:

9:00 - 6:00 starting March 25th through November

Preferred Start Date*

MonthDayYear

Preferred Time Slot and/or Range*

It is possible that your preferred start date and/or time slot will not be available. We appreciate your flexibility and understanding. Please elaborate on your availability and if possible provide a few times that might work for scheduling your lessons:

Preferred Location*

*Ms. Dianne’s lessons are limited to students 6 mos. through 4 yrs. old

Preferred Lesson Length

Are you with Water Smart Tots (WST)?

Please send your award email to your instructor and let us know if you plan to have any lessons beyond what is provided.

Adult Students, please use this area to provide your emergency contact information. Keep in mind, the Parent #1 Email will receive the response to this registraiton submission, so please use your own email address for that. Thank you.

Parent #1 Name

First NameLast Name

Parent #1 Relationship to Student

Parent #1 E-mail*

Parent #1 Primary Phone Number*

Area CodePhone Number

Parent #1 Secondary Phone Number

Area CodePhone Number

Parent #2 Name

First NameLast Name

Parent #2 Relationship to Student

Parent #2 E-mail

Parent #2 Primary Phone Number

Area CodePhone Number

Parent #2 Secondary Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student #1 Name*

First NameLast Name

Student #1 Birth Date*

MonthDayYear

Student #1 Experience with CSA Instructor*

Has Student #1 Seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? Please note if the student has ever had seizures of any kind.*

Student #1 Prior Swim Instruction/Water Experience:*

What did Student #1 learn previously with us?

What would you like Student #1 to learn this year?*

Student #2 Name

First NameLast Name

Student #2 Birth Date

MonthDayYear

Student #2 Experience with CSA Instructor

Has Student #2 Seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? Please note if the student has ever had seizures of any kind.

Student #2 Prior Swim Instruction/Water Experience:

What did Student #2 learn previously with us?

What would you like Student #2 to learn this year?

Student #3 Name

First NameLast Name

Student #3 Birth Date

MonthDayYear

Student #3 Experience with CSA Instructor

Has Student #3 Seen a Medical Specialist or had any non-routine, health or behavioral issues, please explain? Please note if the student has ever had seizures of any kind.

Student #3 Prior Swim Instruction/Water Experience:

What did Student #3 learn previously with us?

What would you like Student #3 to learn this year?

Photo/Video Release: I give permission to Cutri Swim Academy and its instructors to photograph and record and to utilize photographs or other likenesses of me and/or my minor child(ren) on videotape, audiotape, photograph or any other medium in all forms of advertising, trade and any other lawful purposes including but not limited to: print advertising, photographs, video, website, and social media. I further consent to the use of my name, voice and/or biographical data in connection with such use.

I have read the above and agree.I have read the above and do not agree to a photo/video release. ***If you choose this option, please remind your instructor to refrain from taking photos during lessons.

Release of Liability: I release and hold harmless Cutri Swim Academy its owners, operators and instructors from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participants and/or the undersigned, while in or upon the premises or any premises under the control and superivision of Cutri Swim Academy, its owners, operators, pool hosts, or in route to or from any of said premises. I also acknowledge that enrollment, participation in or completion of lessons in no way implies that the participants are drown proof or water safe and that as the parent or legal guardian of the participants, I am ultimately responsible for my child's safety in or around water and must at all times ensure appropriate, vigilant and persistent supervision.*

I have read the above and agree

Assumption of Risk: I understand, agree and acknowledge that there are risks inherent in sports activities conducted by Cutri Swim Academy and its instructors. These activities may be of a hazardous nature and/or may include swimming, diving and a variety of strenuous exercise and physical activities. With the full understanding of the facts, I state that to the best of my knowledge, the participants I am registering have no medical, physical, or emotional conditions that would hinder or prevent safe participation in Cutri Swim Academy programs.*

I have read the above and agree

Enrollment Review and Payment Policies: I understand that I am enrolling for swim lessons with Cutri Swim Academy and that the information submitted on this enrollment form will require review as it is the intent of Cutri Swim Academy to provide each participant with an individualized, effective and safe learning experience. I acknowledge that in some health-related cases, Cutri Swim Academy may not be able to provide services. I certify that all medical/health information I have provided is correct and true and agree to provide additional information, including a physician's clearance if requested, prior to the beginning of any lessons. I understand that in order to secure my child(ren)'s selected lesson time(s) I must pay all applicable registration fees per the instructions sent to me. I understand that participant enrollment may be canceled if payment is not received.*

I have read the above and agree

Registration Fees:

Upon submission, you will see a pop up confirming your registration has been sent.

You will be contacted by your instructor within 48 hours with instructions to submit your registraiton fee. This fee is non-refundable. Without submission of your reistraion fee, your start date and time slot/place on the waiting list will not be held.

New Student $60

2nd Year student $30

3rd Year & Beyond $0

Weekly Tuition Rates:

Weekly tuition is to be paid poolside, each Monday you are in lessons. See Lesson Guidelines.

CSA Valrico $100

CSA Riverview $100

Typing your full name below constitutes full agreement to the terms outlined above and provides electronic signature required for enrollment:*

Cutri Swim Academy Registration

Parent/Guardian or Emergency Contact Information

Student Information