Registration
Blue Gems Swim Family Swim (parent registration) - Family Swim is a great way for students to further practice their skills while also spending precious family time together. Our Manager will also be available on the pool deck to assist with any questions, exercise recommendations or skill assessments if requested.
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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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
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OH
OK
OR
PA
RI
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TN
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UT
VA
VT
WA
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Zip:
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Emergency Contact Info (Name, relation, phone #)
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Medications (Leave blank if NONE):
Student understands English?:
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Gift Card? Last 4 digits?:
Promo Code? :
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Medications (Leave blank if NONE):
Student understands English?:
*
Gift Card? Last 4 digits?:
Promo Code? :
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Medications (Leave blank if NONE):
Student understands English?:
*
Gift Card? Last 4 digits?:
Promo Code? :
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Medications (Leave blank if NONE):
Student understands English?:
*
Gift Card? Last 4 digits?:
Promo Code? :
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Medications (Leave blank if NONE):
Student understands English?:
*
Gift Card? Last 4 digits?:
Promo Code? :
Additional Information:
Participation Policies
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USwim Club LLC, an Illinois limited liability company doing business as Blue Gems Swim School and doing business as Windy City Aquasprites (hereinafter, "Blue Gems" or "we" or "Windy City Aquasprites") and the undersigned (hereinafter "Participant") agree that the following participation policies shall govern the relationship between the parties including but not limited to Participant's purchase and acceptance of services from Blue Gems and use and occupancy of Blue Gem's property. In the event that the person receiving services from Blue Gems and/or using and occupying Blue Gems property is a minor, these participation policies shall also be applicable to such minor's parents, guardians, persons who pay for Blue Gems' services on behalf of such minor and any other person who enters upon Blue Gems' property in connection with such minor receiving services from Blue Gems. All such persons shall be deemed "Participants" for purposes of these participation policies. Blue Gem's participation policies may be modified from time to time at Blue Gem's sole discretion. Blue Gem's applicable participation policies are posted on Blue Gem's website at WWW.BLUEGEMSSWIMSCHOOL.COM (hereinafter, "Website"). By doing business with Blue Gems and accepting services from Blue Gems, Participant agrees that it has read, understands, acknowledges and agrees to be bound by any and all participation policies posted on Blue Gem's website as may be modified from time to time. Payment Information: - Tuition payment is due at the time of enrollment. Participants will not be added to event and/or cannot begin instruction until tuition is paid in full. . - We require that a bank account, credit card, or debit card be on kept on file. Fees will be automatically charged on the first day of each month for that month's enrollment. It is the responsibility of the card holder to ensure that any credit cards or debit cards do not expire and, if so, are timely replaced. If Blue Gems is unable to process payment and payment is not provided within five (5) days of the due date, the participant will not be allowed to participate in the event until payment is made in full. - Due to operational costs no refunds, credits or transfers will be issued. If the Participant has a fever or contagious disease, they are not allowed to participate until said illness is resolved. They may only return after they are no longer sick and able to transmit their illness to others. - Any Participant under the age of 3, or those who are not potty trained, are required to wear two types of swim diapers. One disposable swim diaper and one reusable swim diaper on top. Note: wearing 2 disposable swimming diapers is not allowed. Diapers may be purchased at our front desk. - We advise all Participants enrolled for swim and synchronized swimming lessons to wear a swim cap during classes. - No running deck or rough play allowed on the premises. Please be respectful to other Participants and instructors. If event is cancelled Blue Gems will make every effort to notify Participants as soon as possible. Blue Gems reserves the right to use a substitute teacher for lessons as needed. - Participant acknowledges and agrees that Blue Gems may take photographs and videos of Participant, the undersigned and any other persons associated with Participant who enter upon Blue Gems' property. Participant and the undersigned agree that Blue Gems may use such photographs and video for purposes of marketing Blue Gems' business. Use of such photographs and videos may include the name, image, likeness and voice, in any and all forms of media, of Participant, the undersigned and any other persons associated with Participant who enter upon Blue Gem's property. - Instructors may need to touch the participant in order to perform lessons. Instructors are expected to use the utmost discretion when dealing with participants in order to avoid even the appearance of impropriety. - All merchandise returns and exchanges must
I've read the above and agree.
COVID-19 Policies and Waiver of Liability & Indemnification
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To prevent the spread of coronavirus (COVID 19) and reduce the risk to our athletes, members, guests and employees, we are requiring each person entering the Blue Gems Swim School facility and/or practices is required to conduct self health-screening before each practice - your participation is important to help us take precautionary measures to protect you, and everyone during the practices. The undersigned, on behalf of himself, herself or any minor child for whom the undersigned is legally responsible (each a "Participant") in consideration for receipt of services from USwim Club LLC, an Illinois limited liability company doing business as Blue Gems Swim School (hereinafter, "Blue Gems") and/or in consideration for using and occupying Blue Gems' property agrees as follows: 1) Use and occupancy of Blue Gems' property may result in Participant being exposed to Covid-19. Participant willingly chooses to enter upon Blue Gems' property with full knowledge that doing so may result in Participant being exposed to Covid-19. Participant fully assumes the risk of illness or death related to Covid-19 arising from use and occupancy of Blue Gems' property. 2) Participant, for himself or herself and on behalf of Participant's family, spouse, estate, heirs, executors, administrators, assigns and personal representatives, hereby forever releases, waives, discharges and covenants not to sue Blue Gems Swim School, USwim Club, LLC and each of their affiliates, owners, members, shareholders, officers, directors, agents and employees in connection with any and all claims, demands, losses, damages and liabilities that Participant may suffer as a result of being exposed to or contracting Covid-19 while using or occupying Blue Gems' property. 3) Participant indemnifies and holds harmless Blue Gems Swim School, USwim Club, LLC and each of their affiliates, owners, members, shareholders, officers, directors, agents and employees in connection with any and all claims, demands, losses, damages and liabilities that Participant may suffer as a result of being exposed to or contracting Covid-19 while using or occupying Blue Gems' property. 4) In the event that Participant has been diagnosed with Covid-19, Participant will not enter upon Blue Gems' property for a period of not less than 14 days following the date on which Participant is deemed to have recovered. Participant is deemed to have recovered when Participant has received negative results of an FDA Emergency Use Authorized molecular assay for Covid-19 from at least two consecutive nasopharyngeal swab specimens collected more than 24 hours apart. 5) In the event that Participant has been in direct contact with any person who has been diagnosed with Covid-19, Participant will not enter upon Blue Gems' property for a period of not less than 14 days following the date on which Participant received a Covid-19 diagnostic test confirming that Participant was not infected with Covid-19. 6) Participant will not enter upon Blue Gems' property if Participant has experienced any of the following symptoms within the previous 14 days: (i) fever or chills; (ii) cough; (iii) shortness of breath or difficulty breathing; (iv) fatigue; (v) muscle or body aches; (vi) headache; (vii) new loss of taste or smell; (viii) sore throat; (ix) congestion or runny nose; (x) nausea or vomiting; (xi) diarrhea. Subject to change based on CDC (Center for Disease Control) guidelines.
I've read the above and agree.
Informed Consent and Waiver/Release of Liability
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By accepting services from Blue Gems and/or using and occupying Blue Gems' property, Participant agrees to indemnify, hold harmless and forever discharge and release Blue Gems Swim School, USwim Club, LLC and each of their affiliates, owners, members, shareholders, officers, directors, agents and employees from any and all claims, demands, losses, damages and liabilities that Participant may suffer as a result of any act, accident, illness, injury, death or damage, loss or destruction of any personal property arising or resulting from any services provided by Blue Gems or as a result of using and occupying Blue Gems' property. Participant understands, acknowledges and agrees that participation in services provided by Blue Gems and the use and occupancy of Blue Gems' property has an inherent risk of injury which may include, but is not limited to, soft tissue injuries, fractures, paralyzing injuries, brain injuries, and death. Participant represents and warrants that Participant has no medical, physical, mental or emotional conditions or other impediments which would jeopardize Participant's safe participation in services offered by Blue Gems or the use and occupancy of Blue Gems' property. Any Participant that participates in lap swimming or swimming in the deep area of the pool during any family swim time represents and warrants that such Participant is an experienced swimmer who is capable of swimming without the assistance of any other person or device. Consent for Emergency Medical Treatment: In the event of a medical emergency where Participant is unable to act for himself or herself or where the Participant is a minor and such Participant's parents or legal guardians are not immediately available to act on behalf of such Participant, Blue Gems is authorized and directed to assist Participant by arranging for the fire department, police department, paramedics or any licensed medical professional to provide medical services to Participant. Blue Gems and all persons associated with Blue Gems are hereby indemnified and held harmless against all liability, losses and damages suffered in connection with any medical services provided to Participant.
I've read the above and agree.
Privacy Policy
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Our Privacy Policy is a part of this Agreement, and a copy of that policy is available on the Website and its terms may change from time to time as described therein. If any portion of these rules, policies, waivers and/or release is held to be invalid under law, the remaining portion shall continue in full force and effect
I've read the above and agree.
Enter your Full Name:
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Other Questions/Comments:
Credit Card Verification:
Card Number:
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Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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Address Line 1:
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City:
State:
AK
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AZ
CA
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CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
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Zip:
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