Application for Swim Lessons

Lake Mohawk Pool

23 West Shore Trail, Sparta, NJ 07871

973-726-3263/973-729-9573

APPLICATION FOR SWIM LESSONS

Family Name ______Date ______

Address ______

City ______State ______Zip______

Email Address ______

Daytime Phone # ______Cell #______

Name of Child
(First & Last Name of Each) / Date of Birth / Age / Skill Level (if known)*

* Skill Levels: 1 – non- swimmer; 2 – places head underwater, front & back float; 3 – front & back float w/kick and arm strokes;

4 – freestyle & backstroke; 5 – recommended advanced swimmer

Pool Members: Yes _____ No_____

COST: Each session consists of 8 classes costing $120.00 per session

CHOOSE: Session 1 (June 29 to July 9) ______Session 2 (July 13 to July 23) ______

Rain Make-Up Dates: July 27, 28, 29

CHOOSE: Beginners (Ages 4-7) 1:00 to 1:30 pm ______

Intermediate (Ages 8-10) 1:30 to 2:00 pm ______

Advanced (Ages 11 & Up) 2:00 to 2:30 pm ______

RELEASE AND INDEMNIFICATION:

For and in consideration of the benefits to me from the use by me and/or my children of this facility, Lake Mohawk Pool, and other goods and valuable consideration, the undersigned, individually and of his/her heirs and personal representative, hereby releases Lake Mohawk Pool, Directors, Officers, Agents and Employees from any and all claims of any kind or nature whatsoever, arising out of the use by me and/or my children of said facility. The undersigned, individually and of his/her heirs and personal representative, further agree to indemnify, defend and forever hold harmless Lake Mohawk Pool, Directors, Officers, Agents and Employees from any and all liability or loss whatsoever, (including any cost of defending claims) arising out of use of said facility.

By signing below, I agree that I will abide by the Lake Mohawk Pool policies and procedures.

______

Parent/Guardian Signature Date