Catalina Swim Lessons Sign-up
This is the form to sign up for swim lessons. You MUST be a member of the Catalina Swim Club. Grandchildren of members are allowed to participate in lessons. Your child must be 4 years old to participate in swim lessons. We will not allow more than 60 kids in lessons due to group sizes. After 60 swimmers have signed up for lessons, a waiting list will begin forming. After filling out this form, you will receive an email, with confirmation of your submission, and another from Jason Kubick in the next 2-3 of days, confirming he has received it, along with how to pay. If you have any questions about lessons, please email Jason Kubick at jasonkubick@gmail.com, NOT the pool. Thank you for your interest in swim lessons!
Which session are you signing up your swimmer? *
Parent(s) Name *
Your answer
Phone # *
Your answer
Alternate Phone #
Your answer
Email *
Your answer
Name of Family Membership *
Your answer
Name of Child #1 *
Your answer
Age of Child #1 *
Your answer
Ability of Child #1 (Please mark the highest level of swimming ability for your child. If you are unsure, please place the child one level down and we will quickly move them up if the swimmer is capable. ***Children who haven't been swimming over the winter will have regressed in ability.) *
Name of Child #2
Your answer
Age of Child #2
Your answer
Ability of Child #2 (Please mark the highest level of swimming ability for your child. If you are unsure, please place the child one level down and we will quickly move them up if the swimmer is capable. ***Children who haven't been swimming over the winter will have regressed in ability.)
Name of Child #3
Your answer
Age of Child #3
Your answer
Ability of Child #3 (Please mark the highest level of swimming ability for your child. If you are unsure, please place the child one level down and we will quickly move them up if the swimmer is capable. ***Children who haven't been swimming over the winter will have regressed in ability.)
Name of Child #4
Your answer
Age of Child #4
Your answer
Ability of Child #4 (Please mark the highest level of swimming ability for your child. If you are unsure, please place the child one level down and we will quickly move them up if the swimmer is capable. ***Children who haven't been swimming over the winter will have regressed in ability.)
Emergency contact during swim lessons *
Your answer
Emergency contact phone # *
Your answer
I, the undersigned parent or guardian, hereby authorize my child or children listed above to participate in the Catalina Swim Club Swim Lessons for the summer of 2018, and hereby forever release and discharge the Catalina Swim Club and its representatives from any suit, judgment, injury, claim, or demand which might result from the participation of said child(ren) in the Catalina Swim Lessons. *
Your answer
I, the undersigned parent or guardian, authorize the Catalina Swim Club staff to obtain emergency medical treatment for my child(ren) in the event I cannot be located and authorize providers of medical care to effect such treatment as may be necessary in their judgment for care. *
Your answer
I, the parent or guardian, give the Catalina Swim Club consent to post my child(ren) in pictures, videos, or other forms of media, posted on the Catalina website, Facebook, Twitter, or Instagram pages. *
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