ROB KNIGHT’S SWIM AMERICA (RKSA)REGISTRATION FORM

Swimmer’s Name:______ / Birthdate: ______ / Lane: ______
2nd Swimmer’s Name: ______ / Birthdate: ______ / Lane: ______
3rd Swimmer’s Name: ______ / Birthdate: ______ / Lane: ______

Parents’ Names: ______

Cell #1:______Cell #2 :______

Address: ______City: ______

Email:______/______Zip: ______

Please list any medical conditions & medications. This is very important, especially since it could involve a swimmer’s focus or motor skills.______

RKSA Policies

Safety:For safety reasons, swimmers must remain on the blue decking until dry.No parents on blue decking!
Locker Rooms:All children over age 3.5 must use the appropriate locker room (i.e. no boys over age 3.5 in the ladies’ locker room).
Equipment:All swimmers in lessons need their personal goggles and those with shoulder-length hair must wear a swim cap.
Plastic Diapers:A plastic swim diaper is required if baby is not 100% potty trained. This applies to Baby & Me classes and Family Swim.
Make-Ups:We do not offer make-ups for any reason during School Year Programming; however, we do offer a complimentary Friday Night Family Swim Pass for lessons missed for any reason.
Dropping Lessons:If you decide to drop lessons for any reason, we will credit your account for the remaining weeks, less a $20 administrative fee per swimmer. If you give RKSA less than 48 hours of notice prior to your regularly scheduled timeslot, you will be charged for that lesson.
Nervous Beginner Semi-Private Lessons:Nervous Beginner classes cannot be rescheduled for any reason.
Payment:We have payment deadlines to hold your current timeslot. Missed or late payments result in forfeiture of your timeslot. RKSA posts payment deadlines at the facility, on the website, and you can sign up for e-mail notices. RKSA accepts payment by cash or check, or Paypal online.
Social Media/Photos:Do not take or post photos that show children, other than your own, or RKSA employees on social media sites.
I agree to assume all responsibility and liability for my children and myself without regard to fault while at Rob Knight’s Swim America. I further agree to release Rob Knight’s Swim America and its employees from all claims and liabilities arising in participation in, or attendance at current or future programs. Swim America has my permission to give CPR and first aid, if necessary. I have listed all medications and medical conditions.

Parent Signature: ______

School Year 2017-2018 – Lesson ChoiceSUMMER 2018 – Lesson Choice

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