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Swim Registration
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Swim Registration
Camp Registration
Private Lessons
Contact
Register Now
Swim registration
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Parent’s Name:
*
Parent’s Email:
*
Session:
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Select a Session
Session V- July 7-July 16 -45min
Time/Age
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Select a time/age
10am: 3-4 years
11am: 5-6 years
Parent’s Cell Number:
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Child’s Name:
*
Date Of Birth:
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Child’s Previous Swimming Experience:
Please list any allergies:
Are the child’s vaccinations up-to-date?
*
—Please choose an option—
Yes
No
Does your child have any special needs or developmental delays?
—Please choose an option—
Yes
No
Please explain:
Child’s Physician Name:
Physician Telephone Number:
May we use your child’s photograph for our website and/or social media?
*
—Please choose an option—
Yes
No
Checkboxes
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I understand the $100 deposit per session to hold my child’s spot in class is non-refundable.
I understand the balance of $250 is due on the first day of class.
I understand that there will be a $25 per-day late fee for balances not paid on time.
I understand that only classes that are rained out or canceled by Swimmers by Jessica will be made up; no other make-ups.
Please type your first and last name if you affirm this statement. “I have enrolled my child in a swimming program of physical activity offered by Swimmers by Jessica. I hereby affirm that my child is in good physical condition and does not suffer any disability that would prevent or limit his/her participation in the program.”
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Please type your first and last name if you affirm this statement. “In consideration of my child’s participation in Swimmers by Jessica, for my child, myself and assigns, I hereby release Swimmers by Jessica and it’s employees and owners from any claims, demands and cause of action arising from my child’s participation in this program.”
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Please type in your first & last name if you affirm this statement. “I affirm that I have read and understand all the requirements listed above.”
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