New Clients

Please contact Starfish Swim School (via phone 916.632.3474 or email starfishswimschool@mac.com) to set up a day and time for lessons.

This registration form should only be completed after a lesson spot has been confirmed with Starfish Swim School. Submitting this form does not place you on the Priority List and will not determine scheduling order.

PAYMENT METHODS PAYPAL, CREDIT CARD, CHECK OR CASH. If you would like to pay offline via check or cash, please call 916.632.3474

"*" indicates required fields

1Swimmer Information

2Parent/Guardian Information

3Waiver 1

4Waiver 2

Swimmer's Information

Name

First Last

Age

Lesson Day

Lesson Time

Swim Goals

Health Conditions

Are there any physical or medical conditions that we should be aware of? Please discuss your concerns with your child’s instructor during his/her class time.

Parent/Guardian Information

Name

First Last

Home Phone

Cell Phone

Emergency Phone

Address

Street Address Address Line 2 City State ZIP Code

PARENT/GUARDIAN OF MINOR WAIVER

In consideration of being allowed to participate in any way in STARFISH SWIM SCHOOL lessons, I the undersigned acknowledge, appreciate, and agree that:

There is risk involved with this activity and I knowingly and freely assume all such risks, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS, STARFISH SWIM SCHOOL lessons, and their officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lesser of premises used for the activity (“releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, AND FULLY UNDERSTAND ITS TERMS, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHT BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

In addition I understand that while participating in swim lessons I may be photographed. I understand and agree that the photographs may be used in whole or part, at any time, in composite or distorted form, in color or otherwise and my be displayed through any medium. By entering my name below I authorize any initial and any subsequent disclosure or publication of the photographs at any time.

NO MAKE-UPS, NO CREDITS, NO REFUNDS, NO SWITCHING CLASSES

Signature*
By signing your name you agree to the above.

*
I accept these terms.

Date*
MM slash DD slash YYYY

THIS IS TO CERTIFY THAT I, AS PARENT/GUARDIAN WITH LEGAL RESPONSIBILITY FOR THIS PARTICIPANT, DO CONSENT AND AGREE TO HIS/HER RELEASE AS PROVIDE ABOVE OF ALL THE RELEASEE, AND, FOR MYSELF, MY CHILD AND OUR HEIRS, ASSIGNS, AND NEXT OF KIN, I RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LIABILITIES INCIDENT TO MY MINOR CHILD’S INVOLVEMENT OR PARTICIPATION IN THESE PROGRAMS AS PROVIDE ABOVE, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, TO THE FULLEST EXTENT PERMITTED BY THE LAW.
NO MAKE-UPS, NO CREDITS, NO REFUNDS, NO SWITCHING CLASSES

***important parking information! ***

Please do not arrive more than 5–10 minutes before your scheduled lesson time.

Lessons are held at 3491 Colvin Dr., Loomis, CA 95650. Please park in front of the house or in the driveway if space is available. When you arrive, please go through the open gate on the left side of the house to access the pool area.

Signature*
By signing your name you agree to the above.
*
I accept these terms.
Date*
MM slash DD slash YYYY