Use the form below to secure your spot at Scuba's Pool Party! We will be enjoying THREE full hours of supervised fun including, pool games, arts & crafts, swim time and PIZZA! Bring your swimsuit, smiles, and laughter! Members: $20 per attendee, $50 max/family; Non-Members: $25 per attendee, $50 max/family* *Non-members will be charged $25 per attendee ($50 max/family) unless the guest of a member.
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
(Not Contact #1 or #2)*
Students entered below will be added to your family's account
Additional Information:
Informed Consent & Waiver
I, the undersigned, as the parent/legal guardian of the child(ren) listed on this form agree and understand that swimming is a hazardous activity, and I recognize there are risks inherent in the sport of swimming, including, but not limited to, paralyzing injuries and death. In registering my minor child(ren) to participate in Atlantis Swim Academy, LLC swim lessons, programs, and/or events, I am agreeing to indemnify and hold harmless Atlantis Swim Academy its instructors, officers, directors, agents, and employees against any liability resulting from any injury that may occur to my child(ren) while participating in Atlantis Swim Academy, LLC swim lessons, programs, or events. I also agree to indemnify Atlantis Swim Academy, LLC for any damages incurred arising from any claims, demand, action, or cause of action by my child(ren). Atlantis Swim Academy, LLC assumes no responsibility for any personal property placed in or about the facility. As the parent/guardian, I authorize any representative of Atlantis Swim Academy, LLC to have my child(ren) treated in any medical emergency during their participation in Atlantis Swim Academy, LLC swim lessons, programs, or events. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and emergency transportation for the participant.

I've read the above and agree.
Photos and/or Video Release

I also understand that photos and/or video are occasionally taken at Atlantis Swim Academy, LLC, and any photo and/or video taken of my child(ren) may be used for Atlantis Swim Academy, LLC publicity and promotional purposes. I hereby grant permission to Atlantis Swim Academy, LLC to use, edit, and reuse my child(ren)'s photograph or likeness in any publicity or promotional media materials including use in print, on the Internet, and all other forms of media. I also hereby release Atlantis Swim Academy, LLC and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

I've read the above and agree.
I understand and agree that I must pay all fees and charges associated with ANY event hosted by Atlantis Swim Academy unless otherwise stated. If I fail to make the required payments I understand that I may lose my enrollment/secured spot in the class/event.
I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*