Hubbard Survival Swim School Registration Form
Please complete this form only after your lesson time has been scheduled. This form collects important information about your child and includes required waivers and acknowledgements to ensure a safe, smooth lesson experience.If you have questions while completing this form, feel free to reach out — we’re happy to help.
Did you schedule lessons with Chloe already and have a start date?
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Yes
If the answer is not yes, please fill out the lesson request form and not this registration form. Thanks!
Parent/Guardian Information
Parent 1 Name
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First Name
Last Name
Relationship to student
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Parent 1 E-mail
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Parent 1 Phone Number
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-
Area Code
Phone Number
Parent 2 Name
First Name
Last Name
Relationship to Student
Parent 2 E-mail
example@example.com
Parent 2 Phone Number
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Area Code
Phone Number
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
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North Shore Aquatic Complex
Referred by someone
Google
Social Media
Swimmer Information
Student 1 Name
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First Name
Last Name
Student 1 Birthday
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-
Month
-
Day
Year
Date
Student 1 Prior Experience with Hubbard Survival Swim
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New Student
Returning student learning next step of lessons
3rd year + (has completed a full program and refresher)
Is there anything you’d like us to know to best support your child during lessons?
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Please include any non routine medical visits or behavioral issues that would be helpful to know to best support your child.
Please share any prior swim or water experience your child has had (if any).
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The more detail the better so we can best support your child during lessons
Do you have a pool, live on the water (canal/lake/open water), have a boat? Please check all that apply.
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Pool
Open water
Canal
Lake
Boat
None
What did swimmer 1 previously learn with us?
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Float
Swim/float/swim
Continuing lessons with you
We have not joined your lessons yet!
What is your goal for your child during this set of lessons?
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Float
Swim to Float
Strokes (has completed swim float swim)
Student #2 Name
First Name
Last Name
Student 2 Birthday
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Month
-
Day
Year
Date
Student 2 previous experience with Hubbard Survival Swim School.
New Student
Rollback to float
Swim float swim
Refresher
Is there anything you’d like us to know to best support your child during lessons?
Please include any non routine medical visits or behavioral issues that would be helpful to know to best support your child.
Please share any prior swim or water experience your child has had (if any).
The more detail the better so we can best support your child during lessons
What did swimmer 2 previously learn with us?
Float
Swim to float
Continuing lessons with you
This is our first time joining your lessons!
What is your goal for your child during this set of lessons?
Please select the time & start date you scheduled for.
If scheduling multiple children please choose the earlier time slot.
Start Date & Time
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Policies & Waivers
I understand that instructor assignments are part of the program structure and may vary based on scheduling and availability.
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Yes, I understand.
Because survival swim lessons involve water activity, we require the following acknowledgment to ensure safety and clarity for all families.
Release of Liability: I release and hold harmless Hubbard Survival Swim School, LLC 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 under the control and supervision of Hubbard Survival Swim School, LLC, its owners, operators, pool hosts, or in route to or from any of the 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 the water and must at all times ensure appropriate, vigilant and persistent supervision.
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I have read the above and agree.
Assumption of Risk: I understand and acknowledge that swim lessons involve inherent risks associated with physical activity and water exposure. I voluntarily assume responsibility for these risks on behalf of my child and agree to provide any additional medical information if requested prior to lessons beginning.
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I have read the above and agree.
Enrollment Review and Payment Policies: I understand that I am enrolling for swim lessons with Hubbard Survival Swim School, LLC and that the information submitted on this enrollment form will require review as it is the intent of Hubbard Survival Swim School, LLC to provide each participant with an individualized, effective and safe learning experience. I acknowledge that in some health-related cases, Hubbard Survival Swim School, LLC 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’s selected lesson time I must pay all applicable registration fees and weekly fees per the instructions sent to me. I understand that participant enrollment may be cancelled if payment is not received.
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I have read the above and agree.
Cancellation and late policies: I have read and agree to the Policies & FAQ page, including attendance, cancellation, late arrival, and scheduling policies.
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I have read the above and agree.
Payment policy: I understand that weekly tuition and applicable fees are required to secure and maintain my child’s scheduled lesson time and agree to follow the payment process provided.
I have read the above and agree.
Signature
Signing your name below constitutes that you are in full agreement to the terms outlines above and submits your electronic signature.
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Please type your name.
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Ful Name
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I consent to an electronic signature
Submit
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