Registration

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Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *

Students entered below will be added to your family's account

Add New Student #1:

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Questions/Options:


Child Shirt Size*
Does your child have any prior swimming experience?*
Are they comfortable in Deep Water?*
Known Allergies to drugs or foods?*
Emergency Contact Information (Name, Relationship, Phone Number)*
Parents Name*
Parent's Email*
How did you hear about us?*

Additional Information:

RELEASE OF LIABILITY

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PLEASE READ THOROUGHLY BEFORE SIGNING

In consideration of being allowed to participate in any way in the Mission Viejo Nadadores Swim and Dive School, its related events and activities, I, (name of participant), the undersigned, acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation;

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, and hold harmless the Mission Viejo Nadadores, their offices, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity (“Releasees”), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

For Parents/Guardians of participants of minority age (under 18 at the time of registration), this is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to this here release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the Releasees to the fullest extent permitted by law.

This release of liability will be valid for the entire period the participant is enrolled in the Mission Viejo Nadadores programs. We have the right to change this policy at any given time.

I've read the above and agree.

Photo Waiver

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I've read the above and agree.

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