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Swimming Lessons
SWIMMING LESSONS 2010
Sessions consist of 8 hours: 1 hr/day for 4 days/wk for 2 weeks, Mon. – Thurs. (Friday is used as make-up day).
A maximum of 6 students per session allowed. It will be on a first come, first serve basis.
Cost: If attending our camp, swimming lessons are $65 per child. If not attending our camp, the cost is $75 per child. For those attending camp, transportation will be provided to and from swimming lessons. Payment is due at registration. There are NO REFUNDS!!
Swimming Lessons will be offered during the following sessions: Session 1: June 7 – 17 at 9:30 – 10:30 AM Session 2: June 7 – 17 at 11:30 – 12:30 PM Session 3: June 7 – 17 at 1:30 – 2:30 PM Session 4: June 21 – July 1 at 9:30 – 10:30 AM Session 5: June 21 – July 1 at 11:30 – 12:30 PM Session 6: June 21 – July 1 at 1:30 – 2:30 PM Session 7: July 5 – 15 at 9:30 – 10:30 AM Session 8: July 5 – 15 at 11:30 – 12:30 PM Session 9: July 5 – 15 at 1:30 – 2:30 PM
To register, complete the information below, choose 2 session options, and sign the attached waiver. When choosing your preferred sessions, indicate if “weeks” or “times” are more critical. I group students by ability, age, and session choices.
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Student’s Name: __________________________________________________
Session (1st Choice): ______________________ Session (2nd Choice): _____________________
Age: _______ Sex: ___________ # Yrs. Of Swimming Lessons: ____________________________
Father’s Name: __________________________ Mother’s Name: _________________________
Address: ________________________________________________________________________________
City: __________________________ State: ___________ Zip: ____________
Home Phone: ________________ Cell: _________________ Email: ______________________
Emergency Contact: _______________________ Emergency #: ______________________
Father’s Work #: __________________________ Mother’s Work #: ___________________
Payment Type: Check / Cash Date Paid: _____________ Amount Paid: __________
SWIMMING LESSONS
WAIVER OF RESPONSIBILITY AND MEDICAL RELEASE
In consideration of being allowed in the swimming pool owned by Mr. and Mrs. Douglas Oliva, I agree to abide by the rules. SWIMMING, JUMPING AND DIVING ARE POTENTIALLY DANGEROUS SPORTS AND CAN LEAD TO INJURY. I understand that Mr. and Mrs. Douglas Oliva and New Heights Gym, LLC have an obligation to make the students and their parents aware of the risks and hazards associated with the sports of swimming, jumping, and diving. I understand that as a parent, I am responsible in making my child aware of the possibility of injury and to encourage my child to follow all safety rules. I assume full responsibility for my own safety and the safety of my child, understanding and accepting the risks involved with the sport and activities of swimming. I agree not to bring any claim or suit against Mr. and Mrs. Douglas Oliva, New Heights Gym, LLC, the owners, instructors, staff, guests, students, landlord, or any other parties on my behalf or on behalf of my child for any injury or harm sustained by any event short of criminal act, and then only the criminal shall be the subject of that claim or suit. I further agree that I will not cause to be brought, nor encourage a claim or suit. I also agree not to cooperate in the bringing of such a suit or claim, except insofar as I may be legally required to do so. Finally, I shall indemnify Mr. and Mrs. Douglas Oliva, New Heights Gym, LLC, the owners, instructors, staff, guests, students, and any and all additional defendants covered by this agreement for all judgments, costs, attorney fees, and other expenses incurred as a result of a breach of this agreement. Mr. and Mrs. Douglas Oliva, New Heights Gym, LLC, its owners, coaches, and other staff members will not accept responsibility for injuries sustained by a student during instruction, or open workouts, or in the course of any exhibition or clinic in which the child may participate or while traveling to or from the event. With the above in mind, and being fully aware of the risks and possibility of injury involved, I consent to have my child participate in the swimming activities or programs offered by New Heights Gym, LLC. I waive and release all rights and claims for damages that my child or I may have against Mr. and Mrs. Douglas Oliva, New Heights Gym, LLC or its representatives whether paid or volunteer.
I understand that New Heights Gym, LLC staff members are not physicians or medical practitioners of any kind. I, the undersigned, give the instructors, staff and responsible adults the power to authorize medical or other treatment of the student named below. I understand that the instructors, senior students, or others may have some skills in first aid, CPR, and, at their discretion, I authorize them to use those skills and techniques to assist in any circumstances in which they judge their skills would be necessary or helpful. I hereby release New Heights Gym, LLC staff to render first aid to my child in the event of injury or illness, and if deemed necessary by New Heights Gym, LLC staff, the calling of an ambulance for the said child.
Parent’s Signature: ________________________________ Date: __________________
Student’s Name: __________________________________
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