Registration form

LIFESTYLE Swim School Application and Waiver Form

After Calling Lifestyle 561-393-6386, Mail this Form with Payment

Registration fees are due annually and payable prior to the child's first class for the calendar year. Registration fees are non-refundable.Cash or checks are acceptable as payment. Checks should be made payable to Lifestyle and must be mailed (no checks on pool deck) with this completed registration form to: LIFESTYLE SWIM SCHOOL 1298 S/W. 15th Street, Boca Raton, Florida 33486 The undersigned agrees to defend, pay and save free and harmless Lifestyle Swim School, Inc., the facility owners where lessons are conducted and their respective agents, employees' actions, judgments and proceedings of any kind or in favor of anyone whomsoever and from and against all injury or property damage arising directly or indirectly out of, from or on account of applicant's presence at or use of the facilities or participation in any activities or programs applied for hereby or at any time hereafter. My child (children) has been examined by a certified physician within the last year and is physically fit to participate in swim lessons. He or she is free from any contagious disease. I understand missed classes may not be carried over to the next session. I understand that the Lifestyle Swim School is unable to grant refunds. We reserve the right to: accept only those families who abide by our patient child-centered philosophy; to expel those families that do not abide by the philosophy, fail to follow rules, use foul language, or are disrespectful to teachers, staff or fellow classmates.

Signature of Parent or Guardian:_________________________________________________Date:_________________________

Please Print NEATLY

Parents' Names:______________________________________________________________________________________________

Father Mother Last Name

Email address: ________________________________________Website address________________________________________

Local Address:_______________________________________________________________________________________________

Street City State Zip

Home Phone #:________________________________________Mobile Phone #:_______________________________________

Father’s Occupation:___________________________ Employer:______________________ Bus. Phone #:___________________

Mother’s Occupation:__________________________ Employer:______________________ Bus. Phone #:___________________

1. Child's Name __________________________________________________ Age:______ Date of Birth:______________________

First Last Mo. Day Yr.

Briefly describe child's water experience/skills/level_______________________________________________________________

2. Child's Name_ _________________________________________________ Age:______ Date of Birth:______________________

First Last Mo. Day Yr.

Briefly describe child's water experience/skills/level_______________________________________________________________

3. Child's Name_ _________________________________________________ Age:______ Date of Birth:______________________

First Last Mo. Day Yr.

Briefly describe child's water experience/skills/level_______________________________________________________________

Note any special conditions, needs, health concerns or allergies we may need to know of during the swim session:

____________________________________________________________________________________________________________

How did you hear about us:______________________________________________________________

Name of anyone other than parent who may bring or pick up the children:___________________________________________

CLASS FEES, REGISTRATION FEES (Please Print) Enclosed is my check for the following:

2007

Child’s Name	Session# & Class Name	Days and Time of Class	2008 Reg. fee + class fee = total
			$35 (1st Child) + =
			$25 (2nd Child) + =
			$15 (3rd Child) + =

Class Location_ _____________________________________ Date Paid_ __________________________ Grand Total $_ ____________