New Jersey Swim Schools, Inc. Online Registration

Registration

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Thanks for making Njswim your choice for quality swim lessons. Please complete the registration form in its entirety. Once we receive your information, we will reach out to you to set up a time for a swim skills evaluation. Credit cards will not be billed until your class is confirmed. See you at the pool!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Health Insurance Carrier

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Special Needs*

How we can help your child be successful at Njswim? Learning style or strategies at home etc*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Photo Release (Y/N)*

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Special Needs*

How we can help your child be successful at Njswim? Learning style or strategies at home etc*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Photo Release (Y/N)*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Special Needs*

How we can help your child be successful at Njswim? Learning style or strategies at home etc*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Photo Release (Y/N)*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Special Needs*

How we can help your child be successful at Njswim? Learning style or strategies at home etc*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Photo Release (Y/N)*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

Special Needs*

How we can help your child be successful at Njswim? Learning style or strategies at home etc*

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Photo Release (Y/N)*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Medical Emergency

The undersigned gives permission to New Jersey Swim Schools, Inc., its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restictions, or condition and/or declare the paricipant to be in good physical and mental health. I request that our doctor/physician ________________ be called and that my child be transported to ______________________ hospital. Please include physicians' phone number _______________.

I've read the above and agree.

Payment Information/ Credits

Payment Information: Tuition will be charged by credit card on the first day of each month. There is an registration fee of $25 per family.
Credits: All credits issued will be program credits, posted to your Njswim account to be used for future swim lessons. No cash refunds.

I've read the above and agree.

Make-Up/Cancellation Policy

Make-up Policy: Njswim offers make-up lessons for missed classes due to illness or injury only. In addition to our make up policy, we issue two "vacation make ups" per annual enrollment, per student. Vacation make ups are two missed classes for reason outside of illness or injury, that can be rescheduled. If your child(ren) are going to miss swim class, please notify the office. Make up classes can be scheduled through the office at any time.. However, upon scheduling, a makeup class can not be booked further than 7 days in advance. Make up classes can be scheduled in other class days/times with availability, and that are of your child's swim level.

Cancellation Policy: Njswim requires written notice of cancellation . Njswim runs on a rolling membership, meaning once your child is enrolled, he/she will swim uninterrupted from month to month until a written notice of cancellation is submitted to your Njswim office no later than the 10th of each month, for the upcoming month (for example July 10th for August cancellation). Notice of cancellation forms can be requested through the office. We understand that things do come up and schedules do change-We greatly appreciate the cooperation of our families by adhering to our cancellation guidelines.
Our calendar, which is posted on the website and displayed onsite in the pool area, indicates the last day in each billing cycle that you are able to notify us of your intention to cancel for the following billing cycle. If you have any questions regarding when you need to give us notice, please refer to this calendar.

I've read the above and agree.

Signature Text/Release of Liability

As the legal parent or guardian, I release and hold harmless New Jersey Swim Schools, Inc., its owners and operators from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of New Jersey Swim Schools, Inc., its owners and operators or in route to or from any of said premises.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*