Lessons, Diving, Water Polo, Masters, Summer League, & Aqua Jogging Registration Form
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For which of the following are you registering your swimmer? *
Choose one
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Swimmer's First Name & Middle Initial *
Your answer
Swimmer's Last Name *
Your answer
Swimmer's Birthdate *
Month, Day, Year
Your answer
What is the sex of your swimmer? *
Father's First Name
Your answer
Father's Last Name
Your answer
Mother's First Name
Your answer
Mother's Last Name
Your answer
Mailing Address *
Street, City, State, Zip
Your answer
Phone Numbers *
Enter multiple numbers separated by a comma
Your answer
Email address *
You MUST enter a contact email address
Your answer
Fill in Session, Level, Day and Time *
Enter Group or Private/Semi-Private Lesson. For Private Lessons, please indicate instructor. Also indicate if you are registering for Intro to Synchro or Intro to Diving
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Choose a 2nd Option for Day and Time
Your answer
Please read the following statement and check below to confirm your understanding of the lessons insurance. *
I understand that swimming is a HAZARDOUS activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death. The participant hereby agrees to participate in the Swim Cleveland Lessons Program and hereby agrees to indemnify and hold harmless Swim Cleveland/Beachwood Bison Swim Club, its coaches, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in Swim Cleveland Lessons Program. The participant also agrees to indemnify Swim Cleveland/Beachwood Bison Swim Club for any damages incurred arising from any claims, demand, action or cause of action by the participant. The participant authorizes any representative of Swim Cleveland/Beachwood Bison Swim Club to have the participant treated in any medical emergency during their participation in Swim Cleveland Lessons Program. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and transportation for the participant. I have noted on the back of this form any medical/health problems of which the staff should be aware. I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE.
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