Swimming Lesson Registration form & Waiver

Participant Name

First

Last

Age & Date of Birth

Parent/Guardian Name

First

Last

Phone Number

Address

City/Town

State/Province

ZIP/Postal Code

List any special needs your child may have.

How many lessons would you like?

Which Session(s) would you like? check all that apply

3y-5yr, June 3-7, 10:30a-11am

3y-5yr, June 10-14, 10:30a-11am

3y-5yr, June 17-21, 10:30a-11am

5yr +, June 3-7, 11:15am-11:45am

5yr +, June 10-14, 11:15am-11:45am

5yr +, June 17-21, 11:15am-11:45am

Do you need financial assistance?

PLEASE READ CAREFULLY. THIS IS A RELEASE OF LIABILITY AND WAIVER OF CERTAIN LEGAL RIGHTS.
The enrolled participant(s) and/or the parent/guardian of the participant(s) agree and understand that swimming is a HAZARDOUS activity. The participant recognizes that there are risks inherent in taking swimming lessons, including but not limited to, paralyzing injuries and death.
The participant hereby agrees to participate in the La Cygne Community Pool swim lesson program and hereby agrees to indemnify and hold harmless the La Cygne Community Pool, its swim instructors, lifeguards, management, and the City of La Cygne against any liability resulting from any injury that may occur to the participant while participating in the swim lesson program. The participant also agrees to indemnify the La Cygne Community Pool for any damages incurred arising from any claims, demand, action or cause by the participant.
The Participant authorizes any representative of the La Cygne Community Pool to have the participant treated in any medical emergency during their participation in the swim lesson program. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant.

PHOTO RELEASE
I understand that photos and/or videos are occasionally taken within the La Cygne Community Pool facility. The La Cygne Community Pool may use photos and/or videos of my child(ren) for publicity and/or training purposes.

ACKNOWLEDGMENT OF POLICIES AND PROCEDURES I have carefully read the liability release, photo release, and policies and procedures set forth by the La Cygne Community Pool. I am signing with full knowledge of its contents and significance.