Registration
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Come and join us for our Open House! This is a great time to see our facility and try a swim lesson for FREE! We will have trial lessons from 4:00pm-5:30pm and Open Swim from 5:30pm-6:00pm. If you sign up on 5/18 you will have a chance to spin our wheel to win a free prize! Free refreshments as well Hope to see you there!
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Guardian Information
First Name:
*
Last Name:
*
Home Phone:
*
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Photo Release? Yes/No:
*
First time in Swim Lessons? :
*
Can they swim independently?:
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Photo Release? Yes/No:
*
First time in Swim Lessons? :
*
Can they swim independently?:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Photo Release? Yes/No:
*
First time in Swim Lessons? :
*
Can they swim independently?:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Photo Release? Yes/No:
*
First time in Swim Lessons? :
*
Can they swim independently?:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Photo Release? Yes/No:
*
First time in Swim Lessons? :
*
Can they swim independently?:
*
Questions/Options:
Will this be your fist time at Five Star Swim School?
*
Yes
No
Do you allow your child's photo to be taken for our photo album?
*
Yes
No
You will be automatically added to our mailing list, if you wish to opt-out, check here
(checked=yes)
Additional Information:
Waiver
(Show-Hide Details)
The named participant and/or parent/legal guardian of the participant agree and understand that swimming is a HAZARDOUS activity. I also recognize that there are risks inherent in the sport of swimming including but not limited to paralyzing injuries and death. The participant and/or parent/legal guardian of the participant hereby agrees to participate in the swim lessons and other aquatic activities and hereby agrees to indemnify and hold harmless FIVE STAR SWIM SCHOOL its instructors, coaches, managers and employees against any liability resulting from injuries that may occur to the participant while participating in swim lessons and other aquatic activities. The participant and/or parent/legal guardian of the participant also agrees to indemnify FIVE STAR SWIM SCHOOL, for any damages incurred arising from any claims, demands, action or cause of action by participant.
I've read the above and agree.
Code of Conduct
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All persons on premises are required to conduct themselves appropriately. FSSS does not tolerate abusive, violent, destructive, menacing or harassing behavior towards staff members in person, email or phone call. Such behavior will result in removal. Participants running, throwing, yelling, biting, hitting, and other disruptive behavior is not permitted. Parents/Guardians are required to monitor their children and support this policy the entire time they are on premises. There are no exceptions to this policy. Any equipment used in the locker rooms, such as showers, lockers, hair dryers, etc should be used under adult supervision only.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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