Splash Water Safety Aquatics Waiver including Pool Owners
Please read and initial and sign as required for the following information. All efforts to maintain a safe environment including prevention, rescue, and care will be made at all times during your lesson times with Sara Beth Gilbert.
Weather (Initials Needed) *
All weather calls are made by the instructor. If inclement weather reaches the pool area shortly before or during my scheduled lesson, we will exit the pool and reschedule the remainder of the lesson. If thunder and lightning are in the area, we will not resume lessons until 30 minutes from the last strike of thunder or lightening.
Your answer
Cancellation (Initials Needed) *
If the instructor cancels a lesson, a makeup lesson will be offered. If I cancel a lesson, a makeup lesson may or may not be offered. No refunds are allowed if I choose to cancel or cannot attend lessons.
Your answer
Release of Liability (Initials Needed) *
As the legal parent or guardian, I release Sara Beth Gilbert, any of her assistants, and the pool owners from any and all liability, claims, demands, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned while in, upon, or after leaving the premises or any premises under the control and supervision of Sara Beth Gilbert.
Your answer
Assumption of Risk (Initials Needed) *
I understand, agree, and acknowledge that there are risks inherent in sports activities conducted by Sara Beth Gilbert, including but not limited to paralyzing injuries, brain injuries, and death. These activities may be of a hazardous nature and/or may include activities such as swimming, diving, a variety of strenuous exercise, and physical activities. With the full understanding of the facts, I state that to the best of my knowledge, the student listed has no medical, physical, or emotional health conditions which would hinder or prevent his/her participation in Sara Beth Gilbert's programs. If a condition is present, I am providing the necessary doctor's permission and/or my own permission to proceed with swim lessons conducted by Sara Beth Gilbert.
Your answer
Payment Policies (Initials Needed) *
Full payment is to be paid prior to the first lesson. Otherwise, unless prior arrangements with Sara Beth Gilbert are made, my scheduled times will be lost. A payment deadline may exist and I will lose my scheduled times if payment has not been made by the payment deadline. If there are any discrepancies or reasons that the amount cannot be paid at the designated time, Sara Beth Gilbert will be available for discussion at which time a resolution may occur. If payment is not received in a timely manner, Sara Beth Gilbert assumes that the swimmer is not in need of lessons and will be removing his/her name from the roster.
Your answer
Parent/Guardian or Responsible Student Signature *
By typing my full name and submitting this form, I claim that I have read and agreed to this form in its entirety.
Your answer
Date *
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