Request edit access
Swim Lesson Registration
(TO BE COMPLETED BY PARENT/GUARDIAN – one form per child please)
First and Last Name of Participant *
Your answer
Age of Participant *
Your answer
Pool Location *
Your answer
Parent(s) Name: *
Your answer
Address (city, state, zip) *
Your answer
Home phone:
Your answer
Cell phone (where you can be contacted during the day): *
Your answer
E-mail address: *
Your answer
Emergency contact name and phone number: *
Your answer
Any medical issues we should be aware of?
Your answer
Allergies/Food & Medication:
Your answer
Other Parental Requirements:
Your answer
Youth (under the age of 18): I (the Parent/Guardian), do hereby grant permission for my child(ren) (under the age of 18) to participate in the above program. Further, I agree to observe all the rules and regulations of Elite Amenities at all times. I am aware that my child(ren) will be in the pool. Elite Amenities employees or volunteers, will not be held responsible for any accidents or injuries occurring during swim lessons. Elite Amenities employees or volunteers, will not be held responsible for lost, damages, or stolen items. By signing this waiver I authorize the staff of Elite Amenities to provide first aid should my child(ren) get a minor injuring during swim lessons. I further authorize the staff to contact “911” prior to contacting me in the event of an emergency. (Parent/legal guardian will be contacted immediately after 911 is contacted.) *
Required
Please indicate the swim ability of your child. *
Please indicate the times you would prefer: (click all that apply) *
Required
Fee information: *
Required
Please enter your name to verify that you have read and understand the information herein. *
Your answer
I understand that my registration will not be complete until I return to www.eliteamenities.com and confirm payment. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service