Registration

Event:
Start Date/Time: End Date/Time:
Fee per Family: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email: (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
 
Questions/Options:
Member #1 First /Last Name (if minor, list age)*
Member #2 First /Last Name (if minor, list age)*
Member #3 First /Last Name (if minor, list age)*
Member #4 First /Last Name (if minor, list age)
Member #5 First /Last Name (if minor, list age)
 
Additional Information:
 
Automated Monthly Billing
Saved payment method will be charged on the 1st of each month:
-Nicholls personnel family membership- $35 per month
-Single/Couple Membership (2 individuals)- $35 per month
-Family Membership (3 individuals)- $50 per month

-I understand that by signing this form I give authorization to Crawfish Aquatics to initiate credit card or debit card charges for the monthly payments of Summer Membership on the 1st of each month .

-I understand that I must submit written notice (online withdrawal form) by the 25th of the month to cancel membership for the following month. I agree that I will indemnify and hold Crawfish Aquatics harmless against any liability pursuant to this authorization.

-I understand that any request to withdraw after the 25th of the month may have a $10 processing fee.

-I understand I will be assessed a $10.00 handling charge on a declined Automatic Debit transaction.

-I have read and accepted the general and financial policies as stated here. I understand that by signing this authorization, I am entering an agreement with Crawfish Aquatics.

I've read the above and agree.
 
Withdrawal - terms and form
I understand that a withdrawal form must be completed to drop pool membership, by the 25th of the month to drop for the upcoming month.

Drop form is not required for the end of the season- final billing will post on October 1 and all accounts will be suspended from billing after that date. Membership for Summer 2019 is not automatic- you will re-enroll each summer (so no fee carry-over).

I've read the above and agree.
 
Alcohol
I understand that alcohol is not permitted on the premises.
I've read the above and agree.
 
Waiver / Release (Adult)
I acknowledge and understand that swimming is a hazardous activity and that there are risks inherent in the sport of swimming, including but not limited to drowning, fatigue, paralyzing injury and death.

I hereby agree to indemnify and hold harmless Crawfish Aquatics, its management, directors and agents, members, associates and employees against any and all liability for any injury that may occur to myself while present at Crawfish Aquatics or participating in a swimming program, regardless of the cause of the injury or damage. I also hereby agree to indemnify Crawfish Aquatics, its management, directors and agents, members, associates and employees against any damages arising from any injury, property damage, claim, demand, action or cause of action by or on behalf of myself while on the premises of Crawfish Aquatics, regardless of the cause of the injury or damage.

I agree to and hereby authorize any representative of Crawfish Aquatics to provide treatment in the event of any medical emergency which may arise and will pay all costs associated with any medical care and transportation for the participant(s).

I've read the above and agree.
 
Waiver/ Release (Child)
I am the parent/guardian of the minor participant(s) identified herein and enrolled in a swimming program with Crawfish Aquatics. I acknowledge and understand that swimming is a hazardous activity and that there are risks inherent in the sport of swimming, including but not limited to drowning, fatigue, paralyzing injury and death.

I acknowledge that the participant(s) may participate in swimming activities at Crawfish Aquatics. I hereby agree to indemnify and hold harmless Crawfish Aquatics, its management, directors and agents, members, associates and employees against any and all liability for any injury that may occur to the participant(s) while present at Crawfish Aquatics or participating in a swimming program, regardless of the cause of the injury or damage. I also hereby agree to indemnify Crawfish Aquatics, its management, directors and agents, members, associates and employees against any damages arising from any injury, property damage, claim, demand, action or cause of action by or on behalf of the participant(s) while on the premises of Crawfish, regardless of the cause of the injury or damage.

I agree to and hereby authorize any representative of Crawfish Aquatics to have the participant(s) treated in the event of any medical emergency which may arise and will pay all costs associated with any medical care and transportation for the participant(s).

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: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*