1204 Import Drive

New Iberia, LA 70560


Tel: 337-365-3806



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Sessions consist of 8 hours:  usually the sessions are for 1 hr/day for 4 days/wk for 2 weeks, Mon. – Thurs. (Friday is used as make-up day).  But because we travel for competitions often, we ask for flexibility with the schedule as we make adjustments to accommodate the travel.


A maximum of 6 students per session allowed.  It will be on a first come, first serve basis. 


Cost$90 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 10 – 13 & June 17 - 20 at 9:30 – 10:30 AM

            Session 2:        June 10 – 13 & June 17 - 20 at 1:30 – 2:30 PM

            Session 3:        July 8 – 11 & July 15 – 18 at 9:30 – 10:30 AM

            Session 4:        July 8 – 11 & July 15 – 18 at 1:30 – 2:30 PM



To register, complete the information below 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.




Student’s Name:  __________________________________________________    Camper?  __YES or NO______


Session (1st Choice):  ______________________________      Session (2nd Choice):  _______________________


Age:  ______      Sex:  ______     # Yrs. Of Swimming Lessons:  _________   Afraid of Water?  _______________


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:  __________








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:  __________________________________