Welcome to SwimKids Swim School!


Please sign our online waiver by entering your information, and the names of each of your participating children below.

**Please note: the "start/end dates" on this form are internal and are not the date(s) of the party/event you are attending. Thank you!**

Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
Address: *
City: * State: * Zip: *
Emergency Contact Info
Students entered below will be added to your family's account
Additional Information:
I understand that photographs/videos taken or posted to our Facebook page may be used by SwimKids Swim School. We never use a child's name in our marketing without the permission of their parent. **If you do NOT wish for photographs/videos of your child to be posted to our Facebook page or used by SwimKids Swim School - please let us know in the comments/questions section below.**
I've read the above and agree.
Should a medical emergency arise during my child's participation in the SwimKids Swim School swim program, I understand that reasonable effort will be made to contact me. If I cannot be reached, or if it is believed that my child's life or health may be adversely affected by the delay that an attempt to contact me would cause, I consent to the administration of medical treatment and/or surgical procedures deemed necessary by the medical doctor and/or medical facility, and I consent to the immediate administration of life sustaining measures deemed necessary under the circumstances.
I've read the above and agree.
SwimKids Release
Except for conditions that I have disclosed to SwimKids Swim School, to the best of my knowledge there are no physical or other conditions which will interfere with my child's participation. Safety rules are enforced. While our first priority is your child's safety, we must inform you that swimming is not risk free. As a participant or as a parent or legal guardian of a participant in a SwimKids Swim School program, I am fully aware that swimming can be strenuous, hazardous, and difficult. I acknowledge and freely accept the risks and hazards, including collisions, falls and risk of drowning, associated with the participation in swimming. I agree to hold SwimKids Swim Schools, SwimKids Swim School, Inc., DC Swim, Inc., DC Swim Loudoun, Inc., DC Stealth, Inc., and iSwim, Inc., its officers and agents free and harmless for any injuries or damages arising by reason of participation in this program.
I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments: