Family Registration Form

 

Canyon Swim School:
21 Campbell Lane El Sobrante 94803
(510) 223-4600

www.canyonswimschool.com
email us: swimlessons@canyonswimschool.com

Parent/Guardian Name (last) (first)

Address City Zip

Primary Phone Secondary Phone

Work (optional) Email Address

General Information
Student's Full Name Age Date of Birth (mo/day/yr) If previous student, last badge

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Session Registration

Student's Full Name *Desired Class Level *Session # *Preferred Time Choice for Session (3 preferred Time Choices in order)

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Please indicate/explain any health problems: Yes No

Explain:

Questions:

Method of Payment:
•For your protection, please do not include your credit card information with this application.
•We will contact you at a later date to confirm your method of payment.
•Classes will be assigned when payment is received.

Waiver / Release:
   In consideration of being allowed to participate in the activity of swimming and diving, I agree to release Canyon Swim School, any owner, partner, and/or employee from negligence to the fullest extent permitted by law, for any complications or injury that may result to my child(ren), to me or my family while at Canyon Swim School. I understand swimming and diving activities can be dangerous, and that a full range of known and unknown possible injuries can occur. This includes but is not limited to permanent disability and death. I have also communicated in writing to Canyon Swim School any medical or traumatic experiences my child(ren) and covenant to communicate in writing prior to my child(ren) participation in any swimming and diving in the event of any change to the medical or traumatic experiences. I have read the forgoing along with the payment/make-up/cancellation/swim diaper policy and understand its content. I consent to the use for advertising purposes of any and all photographs and/or videos taken of my child(ren) at Canyon Swim School, waiving any and all right to compensation for their use in Canyon Swim School’s advertising. This Waiver/Release shall be effective for so long as my child(ren) participate in the activity of swimming and diving at Canyon Swim School until expressly revoked in writing by me.

I have read and understand the Waiver / Release and agree to the terms and conditions.